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General NPI Number Information
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NPI Number | 1750563847
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Entity Type | Organization
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Legal Business Name | WILD SMILES DENTAL CENTER OF HOUSTON, PLLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 5720 BELLAIRE BLVD STE D
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City | HOUSTON
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State | TX
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Zip | 77081-5513
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Country | US
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Telephone | 713-668-5437
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Fax | 713-668-5433
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Provider Business Mailing Address
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Address Line | 208 W 8TH ST SUITE 810
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City | PUEBLO
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State | CO
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Zip | 81003-3023
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Country | US
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Telephone | 719-562-4447
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Fax | 719-583-1801
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Authorized Official
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Title or Position | MANAGER, LICENSING & CREDENTIALING
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Name | MS. JENELL STRINGER
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Credential |
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Telephone | 615-750-0343
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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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