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General NPI Number Information
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NPI Number | 1750861233
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Entity Type | Organization
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Legal Business Name | VAIL FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 13190 E COLOSSAL CAVE RD STE 150
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City | VAIL
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State | AZ
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Zip | 85641-8822
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Country | US
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Telephone | 520-762-3236
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Fax | 520-762-8058
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Provider Business Mailing Address
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Address Line | 13190 E COLOSSAL CAVE RD STE 150
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City | VAIL
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State | AZ
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Zip | 85641-8822
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Country | US
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Telephone | 520-762-3236
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Fax | 520-762-8058
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEAN BALLEW
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Credential |
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Telephone | 520-762-3236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D7579
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License Number State | AZ
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