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General NPI Number Information
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NPI Number | 1689455008
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Entity Type | Individual
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Provider Name | JUSTIN M FIRTH DMD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 3890 S LINDBERGH #115
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City | ST LOUIS
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State | MO
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Zip | 63127
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Country | US
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Telephone | 314-843-5553
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Fax | 314-487-1146
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Provider Business Mailing Address
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Address Line | 5524 TELEGRAPH ROAD UNIT 101
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City | ST LOUIS
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State | MO
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Zip | 63129
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Country | US
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Telephone | 314-487-1141
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Fax | 314-487-1146
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2021020354
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License Number State | MO
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