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General NPI Number Information
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NPI Number | 1306086954
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Entity Type | Organization
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Legal Business Name | DREAM TEAM FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 6760 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654
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Country | US
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Telephone | 662-470-4621
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Fax | 662-470-4621
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Provider Business Mailing Address
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Address Line | 6760 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7056
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Country | US
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Telephone | 662-470-4621
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Fax | 662-470-4621
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Authorized Official
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Title or Position | OWNER
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Name | DR. VENIS F SIFFRARD
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Credential | DDS
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Telephone | 662-470-4621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3489-08
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License Number State | MS
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