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General NPI Number Information
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NPI Number | 1730381427
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Entity Type | Organization
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Legal Business Name | DR CHRISTIAN R D WILLARD,DDS,PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 523 STATE HIGHWAY 248 SUITE A
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City | BRANSON
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State | MO
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Zip | 65616-7740
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Country | US
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Telephone | 417-336-2404
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Fax | 417-336-4089
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Provider Business Mailing Address
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Address Line | 523 STATE HIGHWAY 248 SUITE A
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City | BRANSON
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State | MO
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Zip | 65616-7740
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Country | US
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Telephone | 417-336-2404
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Fax | 417-336-4089
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHRISTIAN WILLARD
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Credential | D.D.S.
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Telephone | 417-336-2404
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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 | 15330
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License Number State | MO
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