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General NPI Number Information
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NPI Number | 1053545665
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Entity Type | Individual
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Provider Name | DAVID MITCHELL GLASS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 5301 COWHORN CREEK ROAD
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City | TEXARKANA
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State | TX
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Zip | 75503
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Country | US
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Telephone | 318-861-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 821 ONTARIO ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-1118
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Country | US
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Telephone | 901-833-1141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 26442
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3732
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License Number State | AR
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