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General NPI Number Information
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NPI Number | 1952974594
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN MONTANA ORAL AND MAXILLOFACIAL SURGERY LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 307 E PARK AVE
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City | ANACONDA
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State | MT
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Zip | 59711-2320
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Country | US
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Telephone | 406-563-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 105 BLACKTAIL CT
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City | BUTTE
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State | MT
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Zip | 59701-4351
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Country | US
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Telephone | 406-490-8204
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL G SIMS
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Credential | DDS
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Telephone | 406-490-8204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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