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General NPI Number Information
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NPI Number | 1538713342
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Entity Type | Individual
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Provider Name | JOEL C SMITH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1541 E CLARK ST
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City | POCATELLO
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State | ID
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Zip | 83201-4100
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Country | US
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Telephone | 208-232-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 19 RED OAK LN
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City | COVINGTON
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State | LA
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Zip | 70433-5722
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Country | US
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Telephone | 985-237-4588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7261
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-5582
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License Number State | ID
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