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General NPI Number Information
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NPI Number | 1952554974
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Entity Type | Organization
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Legal Business Name | WEST CENTRAL SMILES PA
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/09/2013
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Provider Practice Location Address
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Address Line | 123 1/2 N. FIRST ST.
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City | MONTEVIDEO
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State | MN
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Zip | 56265
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Country | US
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Telephone | 320-235-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 19TH AVE SW SUITE 1
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City | WILLMAR
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State | MN
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Zip | 56201-5288
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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 | DR./CEO
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Name | JEREMY JOHNSON
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Credential |
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Telephone | 320-235-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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