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General NPI Number Information
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NPI Number | 1467345942
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Entity Type | Organization
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Legal Business Name | SMILE CENTER ORAL & MAXILLOFACIAL SURGERY, LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 700 WILDWOOD PLANTATION DR
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City | VALDOSTA
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State | GA
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Zip | 31602-3606
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Country | US
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Telephone | 229-241-1010
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Fax | 507-428-6342
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Provider Business Mailing Address
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Address Line | 700 WILDWOOD PLANTATION DR
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City | VALDOSTA
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State | GA
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Zip | 31602-3606
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Country | US
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Telephone | 229-241-1010
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Fax | 507-428-6342
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Authorized Official
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Title or Position | CLAIMS ADMINISTRATOR
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Name | WENDY DAVIS
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Credential |
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Telephone | 229-241-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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