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General NPI Number Information
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NPI Number | 1699914721
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Entity Type | Organization
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Legal Business Name | FAMILY SMILES DENTAL
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 59 HILLSIDE TRCE SUITE 105
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City | DALLAS
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State | GA
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Zip | 30157-9476
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Country | US
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Telephone | 770-505-4746
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Fax | 770-505-0047
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Provider Business Mailing Address
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Address Line | 59 HILLSIDE TRCE SUITE 105
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City | DALLAS
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State | GA
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Zip | 30157-9476
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Country | US
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Telephone | 770-505-4746
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Fax | 770-505-0047
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. ANDREW ZAMORA
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Credential | DMD
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Telephone | 770-505-4746
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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 | DN012616
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License Number State | GA
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