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General NPI Number Information
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NPI Number | 1972349512
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Entity Type | Organization
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Legal Business Name | SMILE SQUAD INC
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 355 W MAIN ST
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City | LEOLA
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State | PA
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Zip | 17540-2107
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Country | US
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Telephone | 717-884-8807
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 BAYBREEZE LN
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City | BERLIN
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State | MD
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Zip | 21811-9404
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Country | US
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Telephone | 410-382-5760
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ANVARALI MOHAMMADH
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Credential | DMD
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Telephone | 717-884-8807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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