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General NPI Number Information
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NPI Number | 1518144591
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Entity Type | Organization
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Legal Business Name | CEDAR RIDGE DENTAL CENTRE
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 303 POWELL AVE
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City | COLERAINE
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State | MN
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Zip | 55722-0810
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Country | US
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Telephone | 218-245-2451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX J
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City | COLERAINE
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State | MN
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Zip | 55722-0810
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Country | US
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Telephone | 218-245-2451
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Fax |
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. MATTHEW S SCHROEDER
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Credential | DDS
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Telephone | 218-245-2451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11954
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License Number State | MN
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