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General NPI Number Information
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NPI Number | 1043787146
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Entity Type | Organization
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Legal Business Name | RAINTREE DENTAL PC
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 120 S MEMORIAL DR STE F
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City | NEW CASTLE
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State | IN
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Zip | 47362-4991
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Country | US
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Telephone | 765-528-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 10152 FALCON COVE CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-8495
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Country | US
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Telephone | 260-760-0611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES R MILLER
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Credential | DDS
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Telephone | 260-760-0611
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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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