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General NPI Number Information
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NPI Number | 1912749417
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Entity Type | Organization
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Legal Business Name | SMILE LOFT MIDDLE RIVER LLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1390 MARTIN BLVD
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-4104
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Country | US
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Telephone | 410-610-3071
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Fax |
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Provider Business Mailing Address
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Address Line | 12116 DARNESTOWN RD STE L1
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City | NORTH POTOMAC
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State | MD
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Zip | 20878-2227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | VAIBHAV RAI
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Credential | DDS
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Telephone | 610-216-0339
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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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