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General NPI Number Information
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NPI Number | 1619182995
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Entity Type | Individual
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Provider Name | KYLE JOSEPH STUART DMD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 216 N MAIN ST STE B
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City | TRENTON
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State | FL
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Zip | 32693-3427
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Country | US
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Telephone | 352-463-2665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 455
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City | MC INTOSH
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State | FL
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Zip | 32664-0455
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Country | US
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Telephone | 352-463-2665
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Fax | 352-463-6848
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 14667
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License Number State | FL
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