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General NPI Number Information
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NPI Number | 1679795330
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Entity Type | Individual
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Provider Name | MITCHELL ALAN SMOLOW D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 720 HAMPTON RD
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City | SHAVERTOWN
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State | PA
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Zip | 18708-9527
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Country | US
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Telephone | 570-714-4000
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Fax | 570-696-3320
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Provider Business Mailing Address
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Address Line | 720 HAMPTON RD
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City | SHAVERTOWN
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State | PA
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Zip | 18708-9527
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Country | US
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Telephone | 570-714-4000
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Fax | 570-696-3320
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS020248L
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License Number State | PA
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