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General NPI Number Information
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NPI Number | 1588081210
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Entity Type | Organization
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Legal Business Name | DENTAL EXPRESSIONS SC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | N3946 COLUMBIA AVE
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City | FREEDOM
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State | WI
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Zip | 54130-7552
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Country | US
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Telephone | 920-788-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 623 E TALLGRASS DR
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City | APPLETON
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State | WI
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Zip | 54913-7505
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Country | US
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Telephone | 920-428-5416
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT HEIL
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Credential | DDS
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Telephone | 920-428-5416
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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 | 5139-15
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License Number State | WI
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