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General NPI Number Information
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NPI Number | 1740727825
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Entity Type | Organization
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Legal Business Name | ALL SMILES DENTAL CARE
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 3003 GODFREY RD
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City | GODFREY
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State | IL
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Zip | 62035-1808
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Country | US
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Telephone | 618-466-5508
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Fax | 618-466-3515
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Provider Business Mailing Address
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Address Line | 3003 GODFREY RD
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City | GODFREY
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State | IL
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Zip | 62035-1808
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Country | US
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Telephone | 618-466-5508
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Fax | 618-466-3515
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Authorized Official
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Title or Position | OWNER
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Name | DR. RHONDA NICOLE GREEN
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Credential | DMD
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Telephone | 618-466-5508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019024529
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License Number State | IL
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