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General NPI Number Information
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NPI Number | 1750077798
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALTY CENTER OF FALCON LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 7520 BIERSTADT HTS STE 125
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City | FALCON
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State | CO
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Zip | 80831-6177
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Country | US
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Telephone | 719-654-0105
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Fax | 719-218-9013
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Provider Business Mailing Address
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Address Line | 7520 BIERSTADT HTS STE 125
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City | FALCON
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State | CO
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Zip | 80831-6177
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Country | US
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Telephone | 719-654-0105
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Fax | 719-218-9013
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ANDRE SHOOK
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Credential |
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Telephone | 972-869-3789
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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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