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General NPI Number Information
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NPI Number | 1568939593
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Entity Type | Organization
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Legal Business Name | ST.LOUIS CENTER FOR AESTHETIC AND RESTOR. DENTISTRY/LINDBERGH SMILE
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 7934 N LINDBERGH BLVD
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City | HAZELWOOD
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State | MO
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Zip | 63042-3521
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Country | US
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Telephone | 314-831-8086
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 ELBRIDGE PAYNE RD STE 240
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8544
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Country | US
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Telephone | 314-753-8154
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Fax |
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Authorized Official
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Title or Position | SUPPORT SPECIALIST
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Name | RAY WEBER
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Credential |
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Telephone | 314-753-8154
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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 |
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License Number State |
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