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General NPI Number Information
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NPI Number | 1497239917
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Entity Type | Organization
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Legal Business Name | SMILE ORTHODONTICS
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 820 S BARTLETT RD STE 105
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City | STREAMWOOD
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State | IL
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Zip | 60107-2407
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Country | US
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Telephone | 630-830-9700
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Fax | 630-830-9739
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Provider Business Mailing Address
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Address Line | 820 S BARTLETT RD STE 105
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City | STREAMWOOD
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State | IL
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Zip | 60107-2407
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Country | US
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Telephone | 630-830-9700
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Fax | 630-830-9739
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Authorized Official
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Title or Position | MBR
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Name | PRANAV PATEL
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Credential | DDS
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Telephone | 630-452-3810
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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 |
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License Number State |
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