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General NPI Number Information
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NPI Number | 1538794516
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Entity Type | Organization
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Legal Business Name | SHADOW CREEK PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 822 NE ALICES RD
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City | WAUKEE
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State | IA
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Zip | 50263-8857
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Country | US
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Telephone | 515-264-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 5910 FAIRWAY CT
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City | WEST DES MOINES
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State | IA
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Zip | 50266-3851
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Country | US
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Telephone | 515-480-1754
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY I HAMMOND
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Credential | DDS
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Telephone | 515-480-1754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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