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General NPI Number Information
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NPI Number | 1932505583
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Entity Type | Organization
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Legal Business Name | TWIN CITIES SEDATION DENTAL, P.A.
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 808 W BROADWAY AVE SUITE A
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City | FOREST LAKE
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State | MN
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Zip | 55025-3769
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Country | US
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Telephone | 651-674-7096
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Fax |
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Provider Business Mailing Address
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Address Line | 6460 MAIN ST
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City | NORTH BRANCH
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State | MN
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Zip | 55056-7068
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Country | US
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Telephone | 651-674-7096
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Fax | 651-203-7373
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | SARAH M BURT
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Credential | RDH, MDH
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Telephone | 651-674-7096
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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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