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General NPI Number Information
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NPI Number | 1063853281
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Entity Type | Organization
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Legal Business Name | RED RIVER FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1320 N GRAND AVE UNIT B
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City | GAINESVILLE
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State | TX
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Zip | 76240-2813
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Country | US
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Telephone | 702-376-7374
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 ASPEN RD
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City | GAINESVILLE
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State | TX
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Zip | 76240-2947
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Country | US
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Telephone | 702-376-7374
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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. KEVIN DALE STEWART
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Credential | DMD
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Telephone | 702-376-7374
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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 | 24935
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License Number State | TX
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