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General NPI Number Information
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NPI Number | 1588910657
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Entity Type | Individual
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Provider Name | KEVIN DOUGLAS SMITH D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 900 WASHINGTON RD
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City | WEST POINT
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State | NY
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Zip | 10996-1109
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Country | US
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Telephone | 845-938-6475
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Fax |
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Provider Business Mailing Address
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Address Line | 155B GARDNER LOOP # B
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City | WEST POINT
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State | NY
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Zip | 10996-1114
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Country | US
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Telephone | 253-576-2478
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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 | 22DIO2504600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 059103-1
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License Number State | NY
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