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General NPI Number Information
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NPI Number | 1356151757
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Entity Type | Individual
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Provider Name | LOGAN SMITH
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Gender | Male
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 7613 ESTHER CIR
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City | FREDERICK
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State | CO
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Zip | 80504-5881
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Country | US
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Telephone | 303-848-3633
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Fax |
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Provider Business Mailing Address
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Address Line | 6173 S JACKSON GAP CT
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City | AURORA
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State | CO
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Zip | 80016-2797
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Country | US
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Telephone | 303-748-6981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DEN.00206171
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License Number State | CO
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