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General NPI Number Information
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NPI Number | 1235071317
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Entity Type | Organization
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Legal Business Name | STL DENTAL GROUP LLC
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Dates
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Enumeration Date | 04/07/2026
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Last Update Date | 04/07/2026
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Provider Practice Location Address
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Address Line | 3654 GRAVOIS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-4728
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Country | US
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Telephone | 314-865-3838
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Fax | 314-865-2419
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Provider Business Mailing Address
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Address Line | 3654 GRAVOIS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-4728
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Country | US
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Telephone | 314-865-3838
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Fax | 314-865-2419
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Authorized Official
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Title or Position | DENTIST
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Name | TRI LY
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Credential |
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Telephone | 314-865-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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