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General NPI Number Information
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NPI Number | 1205280310
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Entity Type | Organization
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Legal Business Name | STREAMSIDE DENTAL
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 109 E MAIN ST
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City | EVERETT
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State | PA
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Zip | 15537-1259
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Country | US
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Telephone | 814-934-7161
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Fax |
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Provider Business Mailing Address
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Address Line | 109 E MAIN ST
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City | EVERETT
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State | PA
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Zip | 15537-1259
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Country | US
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Telephone | 814-934-7161
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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. DOUGLAS CHRISTOPHER KURTZ
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Credential | D.D.S.
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Telephone | 814-934-7161
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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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