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General NPI Number Information
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NPI Number | 1548843980
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Entity Type | Individual
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Provider Name | SAMUEL R SMITH DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 295 ANDERSON RD
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City | SHELLEY
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State | ID
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Zip | 83274-4927
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Country | US
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Telephone | 208-357-7900
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Fax | 208-357-7904
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Provider Business Mailing Address
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Address Line | 3867 AMARILLO DR
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City | AMMON
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State | ID
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Zip | 83406-5142
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Country | US
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Telephone | 801-633-0768
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D-5496
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License Number State | ID
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