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General NPI Number Information
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NPI Number | 1861591679
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Entity Type | Organization
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Legal Business Name | DANE E. SMITH DDS PC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 565 5TH ST
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City | BROOKINGS
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State | OR
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Zip | 97415-9702
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Country | US
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Telephone | 541-469-5373
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Fax | 541-412-0177
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Provider Business Mailing Address
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Address Line | 3500 CEDAR ST
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City | NORTH BEND
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State | OR
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Zip | 97459-1108
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Country | US
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Telephone | 541-756-3683
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Fax | 541-756-1974
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Authorized Official
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Title or Position | OWNER
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Name | DANE E SMITH
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Credential | DDS
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Telephone | 541-756-3683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D4773
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License Number State | OR
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