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General NPI Number Information
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NPI Number | 1629389077
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN MALONEY COPELAND DDS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 2426 TAYLOR RD
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City | WILDWOOD
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State | MO
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Zip | 63040-1222
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Country | US
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Telephone | 636-273-5866
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Fax | 636-273-5349
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Provider Business Mailing Address
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Address Line | 9000 WATSON RD SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63126-2217
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Country | US
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Telephone | 314-842-7500
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Fax | 314-842-8401
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2010019976
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2010019976
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License Number State | MO
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