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General NPI Number Information
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NPI Number | 1871096123
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Entity Type | Organization
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Legal Business Name | STUART M. SHOFLICK, DMD, PLLC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 155 S MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-3450
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Country | US
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Telephone | 860-236-5455
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Fax | 888-247-6762
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Provider Business Mailing Address
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Address Line | 155 S MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06107-3450
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Country | US
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Telephone | 860-236-5455
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Fax | 888-247-6762
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STUART MARK SHOFLICK
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Credential | DMD
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Telephone | 860-508-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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