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General NPI Number Information
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NPI Number | 1972646610
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Entity Type | Organization
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Legal Business Name | PERFECT SMILE DENTISTRY
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12300 SOUTHSHORE BLVD SUITE 208
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City | WELLINGTON
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State | FL
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Zip | 33414-6237
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Country | US
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Telephone | 561-204-4494
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Fax | 561-204-2840
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Provider Business Mailing Address
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Address Line | 12300 SOUTHSHORE BLVD SUITE 208
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City | WELLINGTON
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State | FL
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Zip | 33414-6237
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Country | US
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Telephone | 561-204-4494
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Fax | 561-204-2840
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ADRIENNE PROANO
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Credential |
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Telephone | 561-204-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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