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General NPI Number Information
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NPI Number | 1245742386
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Entity Type | Organization
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Legal Business Name | ROOTS ORTHODONTICS LLC
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 9370 SW GREENBURG RD
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City | PORTLAND
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State | OR
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Zip | 97223-5442
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Country | US
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Telephone | 503-245-7670
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Fax |
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Provider Business Mailing Address
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Address Line | 9370 SW GREENBURG RD
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City | PORTLAND
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State | OR
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Zip | 97223-5442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RYAN SMITH
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Credential | DDS
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Telephone | 716-601-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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