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General NPI Number Information
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NPI Number | 1851100598
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Entity Type | Organization
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Legal Business Name | FULL SMILE PROSTHODONTICS PLLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 4515 VAN WINKLE DR
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City | AMARILLO
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State | TX
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Zip | 79119-6423
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Country | US
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Telephone | 806-358-0368
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 CIVIC CIR STE 600
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City | AMARILLO
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State | TX
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Zip | 79109-1817
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Country | US
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Telephone | 806-353-1055
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LAUREN AMES HODGES
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Credential |
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Telephone | 806-353-1055
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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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