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General NPI Number Information
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NPI Number | 1699718965
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA DENTAL WEST
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 720 LIMEKILN RD
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City | NEW CUMBERLAND
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State | PA
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Zip | 17070-2358
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Country | US
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Telephone | 717-774-6700
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Fax | 717-774-6740
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Provider Business Mailing Address
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Address Line | 720 LIMEKILN RD
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City | NEW CUMBERLAND
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State | PA
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Zip | 17070-2358
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Country | US
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Telephone | 717-774-6700
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Fax | 717-774-6740
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. SCOTT A MUTSCHLER
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Credential | DMD
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Telephone | 717-774-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DS017834L
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License Number State | PA
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