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General NPI Number Information
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NPI Number | 1841746450
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Entity Type | Organization
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Legal Business Name | BOSCOBEL FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 105 E. BLUFF STREET
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City | BOSCOBEL
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State | WI
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Zip | 53805
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Country | US
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Telephone | 608-375-4549
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Fax | 608-375-4665
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Provider Business Mailing Address
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Address Line | 105 E BLUFF ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1610
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Country | US
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Telephone | 608-375-4549
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Fax | 608-375-4665
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANGELA K SALMON
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Credential |
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Telephone | 608-647-3222
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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 | 1001394
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License Number State | WI
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