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General NPI Number Information
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NPI Number | 1093111650
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Entity Type | Individual
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Provider Name | BRETT HARRIS DMD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 101 FAWCETT RD STE 170
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone | 970-949-7911
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FAWCETT RD STE 170
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone |
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 36102
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 00202386
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License Number State | CO
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