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General NPI Number Information
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NPI Number | 1609301662
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Entity Type | Organization
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Legal Business Name | SMILE EXCHANGE OF TROOPER
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 2544 W MAIN ST
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City | NORRISTOWN
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State | PA
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Zip | 19403-3021
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Country | US
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Telephone | 484-406-5520
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Fax | 484-674-7973
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Provider Business Mailing Address
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Address Line | 5 S. MOREHALL RD
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City | MALVERN
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State | PA
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Zip | 19355
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Country | US
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Telephone | 484-302-2700
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHAEL BUNDY
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Credential | DMD
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Telephone | 85664225200
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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 |
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License Number State |
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