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General NPI Number Information
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NPI Number | 1386274777
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Entity Type | Organization
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Legal Business Name | CRESTVIEW SMILES, PA
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 5170 S FERDON BLVD
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City | CRESTVIEW
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State | FL
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Zip | 32536-9258
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Country | US
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Telephone | 850-897-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 E HIGHWAY 20 STE 101
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City | NICEVILLE
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State | FL
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Zip | 32578-9735
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Country | US
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Telephone | 850-897-4488
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Fax | 850-897-1446
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LOVELYN SILVA
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Credential |
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Telephone | 850-699-6111
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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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