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General NPI Number Information
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NPI Number | 1750978359
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Entity Type | Organization
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Legal Business Name | SMITH DENTAL CARE OF WINDER LLC
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 48 PIEDMONT DR STE 302
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City | WINDER
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State | GA
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Zip | 30680-8132
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Country | US
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Telephone | 706-619-1307
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Fax | 706-510-2594
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Provider Business Mailing Address
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Address Line | 3700 ATLANTA HWY STE 10
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City | ATHENS
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State | GA
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Zip | 30606-7201
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Country | US
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Telephone | 706-619-1307
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Fax | 706-510-2594
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CELESTE JOHNSON
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Credential |
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Telephone | 706-376-2345
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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 |
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License Number State |
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