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General NPI Number Information
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NPI Number | 1831660422
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Entity Type | Organization
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Legal Business Name | AUTHENTIC SMILES FAMILY DENTAL
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Dates
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Enumeration Date | 12/08/2018
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Last Update Date | 12/08/2018
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Provider Practice Location Address
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Address Line | 777 BLACKWOOD CLEMENTON RD
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City | LINDENWOLD
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State | NJ
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Zip | 08021-5966
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Country | US
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Telephone | 267-307-4834
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Fax |
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Provider Business Mailing Address
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Address Line | 112 MINUTEMAN LN
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City | SWEDESBORO
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State | NJ
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Zip | 08085-4234
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Country | US
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Telephone | 267-307-4834
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHAMED OMAR
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Credential | DMD
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Telephone | 267-307-4834
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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 |
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License Number State |
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