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General NPI Number Information
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NPI Number | 1598179913
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Entity Type | Organization
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Legal Business Name | SMILE HAVEN DENTAL CENTER LLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 195 MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-6219
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Country | US
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Telephone | 860-584-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 195 MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-6219
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Country | US
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Telephone | 860-584-2051
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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. MARCELO CROMER MALDONADO
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Credential | D.M.D.
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Telephone | 860-877-6983
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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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