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General NPI Number Information
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NPI Number | 1609197813
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Entity Type | Organization
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Legal Business Name | SMILES OF ARKANSAS DENTAL CENTER, PLLC
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 301 E STADIUM
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City | MAGNOLIA
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State | AR
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Zip | 71753-2034
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Country | US
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Telephone | 870-901-7645
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Fax | 870-234-2030
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Provider Business Mailing Address
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Address Line | 301 E STADIUM
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City | MAGNOLIA
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State | AR
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Zip | 71753-2034
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Country | US
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Telephone | 870-901-7645
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Fax | 870-234-2030
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | GARLAND REESE SHUFFIELD
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Credential |
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Telephone | 870-901-7645
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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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