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General NPI Number Information
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NPI Number | 1881733426
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Entity Type | Individual
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Provider Name | GLENN OWEN SMITH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21320 HAWTHORNE BLVD STE 202
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City | TORRANCE
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State | CA
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Zip | 90503-5668
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Country | US
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Telephone | 310-792-0049
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Fax | 310-792-9030
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Provider Business Mailing Address
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Address Line | 609 PASEO DE LOS REYES
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6615
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Country | US
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Telephone | 310-791-1136
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Fax | 310-792-9030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DK033663
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License Number State | CA
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