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General NPI Number Information
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NPI Number | 1427722081
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Entity Type | Organization
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Legal Business Name | VALLEY SMILES PLLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 17900 TALBOT RD S STE 103
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City | RENTON
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State | WA
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Zip | 98055-8212
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Country | US
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Telephone | 425-448-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 20609 NE 16TH ST
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City | SAMMAMISH
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State | WA
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Zip | 98074
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Country | US
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Telephone | 425-830-4738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JUDSON SCOLES
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Credential | DMD
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Telephone | 425-830-4738
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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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