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General NPI Number Information
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NPI Number | 1477475804
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Entity Type | Individual
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Provider Name | BRIAN MATTHEW TACK
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Gender | Male
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | CARL R. DARNALL AMC 590 MEDICAL CENTER ROAD
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City | FORT HOOD
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State | TX
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Zip | 76544
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Country | US
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Telephone | 254-288-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 340 ARNOLD DR UNIT A
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City | BELTON
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State | TX
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Zip | 76513-6031
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Country | US
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Telephone | 415-724-4708
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13457656-9926
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License Number State | UT
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