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General NPI Number Information
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NPI Number | 1396221909
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Entity Type | Organization
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Legal Business Name | ULTIMATE SMILE DENTAL, PC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 7181 STATE ROUTE 96
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City | VICTOR
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State | NY
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Zip | 14564-8989
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Country | US
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Telephone | 585-924-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 3349 MONROE AVE STE 334
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City | ROCHESTER
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State | NY
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Zip | 14618-5513
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Country | US
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Telephone | 585-820-1250
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RICARDO HUERTA-ANDRADE
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Credential | DDS
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Telephone | 585-820-1250
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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 | 052271
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License Number State | NY
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