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General NPI Number Information
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NPI Number | 1720443567
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Entity Type | Organization
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Legal Business Name | CU SMILE, LLC
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 1400 TRIAD CENTER DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-7351
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Country | US
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Telephone | 636-441-7440
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 TRIAD CENTER DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-7351
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Country | US
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Telephone | 636-441-7440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA BLALOCK
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Credential | DDS
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Telephone | 636-441-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2011015404
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License Number State | MO
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