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General NPI Number Information
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NPI Number | 1518632090
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Entity Type | Organization
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Legal Business Name | SUMMIT FAMILY DENTAL ARTS LLC
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1701 SW US HIGHWAY 40 STE 202
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City | BLUE SPRINGS
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State | MO
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Zip | 64015-4647
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Country | US
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Telephone | 816-229-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 NE LAKEWOOD WAY STE 150
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City | LEES SUMMIT
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State | MO
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Zip | 64064-1997
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Country | US
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Telephone | 816-350-9119
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GREGORY CALLOWAY
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Credential | DDS
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Telephone | 816-721-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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