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General NPI Number Information
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NPI Number | 1922609015
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Entity Type | Organization
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Legal Business Name | CORNER CLINIC DENTAL STG
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 2351 S RIVER RD STE 4
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City | ST GEORGE
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State | UT
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Zip | 84790-8749
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Country | US
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Telephone | 435-709-8786
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Fax |
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Provider Business Mailing Address
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Address Line | 380 E MAIN ST BLDG B2ND
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City | MIDWAY
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State | UT
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Zip | 84049-6801
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Country | US
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Telephone | 435-659-7352
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JACOB HEYWOOD
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Credential |
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Telephone | 435-671-3285
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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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