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General NPI Number Information
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NPI Number | 1730655937
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Entity Type | Organization
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Legal Business Name | SMILE IN FISHERS, LLC
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 9865 E 116TH ST STE 100
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City | FISHERS
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State | IN
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Zip | 46037-9237
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Country | US
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Telephone | 937-206-6837
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Fax |
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Provider Business Mailing Address
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Address Line | 9865 E 116TH ST STE 100
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City | FISHERS
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State | IN
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Zip | 46037-9237
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Country | US
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Telephone | 937-206-6837
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Fax |
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Authorized Official
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Title or Position | OPERATIONS ADMINISTRATOR
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Name | ASHLEY COAD
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Credential |
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Telephone | 317-570-5480
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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 |
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License Number State |
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