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General NPI Number Information
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NPI Number | 1760745194
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Entity Type | Organization
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Legal Business Name | DENTAL SMILES OF AMERICA LLC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1325 AUBURN RD
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 678-495-9500
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Fax | 678-495-9501
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Provider Business Mailing Address
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Address Line | 1325 AUBURN RD
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City | DACULA
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State | GA
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Zip | 30019-1121
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Country | US
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Telephone | 678-495-9500
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Fax | 678-495-9501
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Authorized Official
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Title or Position | DENTIST/OWNER MEMBER
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Name | DR. DEVANG SHAH
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Credential | DMD
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Telephone | 678-495-9500
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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 | DN013630
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License Number State | GA
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