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General NPI Number Information
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NPI Number | 1841545597
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Entity Type | Organization
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Legal Business Name | BRACES R US PC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 8337 SUMMER PARK DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1991
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Country | US
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Telephone | 617-281-7947
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Fax |
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Provider Business Mailing Address
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Address Line | 419 OLD ELKHART RD STE 120
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City | PALESTINE
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State | TX
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Zip | 75801-5922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GUNJAN DHIR
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Credential |
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Telephone | 617-281-7947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 24348
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License Number State | TX
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