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General NPI Number Information
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NPI Number | 1649303397
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Entity Type | Individual
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Provider Name | WILLIAM RONEU REAGAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 444 FOREST SQ
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City | LONGVIEW
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State | TX
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Zip | 75605-4463
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Country | US
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Telephone | 903-758-4431
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Fax | 903-753-5458
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Provider Business Mailing Address
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Address Line | 444 FOREST SQ
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City | LONGVIEW
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State | TX
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Zip | 75605-4463
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Country | US
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Telephone | 903-758-4431
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Fax | 903-753-5458
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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 | 9109
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License Number State | TX
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