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General NPI Number Information
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NPI Number | 1780028969
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Entity Type | Organization
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Legal Business Name | NEW YORK SMILES DENTAL PC
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 2608 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10025-5012
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Country | US
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Telephone | 212-865-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 2608 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 212-865-8280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHUN LEE
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Credential |
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Telephone | 212-865-8280
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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 | 050131
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License Number State | NY
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