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General NPI Number Information
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NPI Number | 1912382318
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Entity Type | Individual
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Provider Name | JONATHAN BEARD DDS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 63355 US HIGHWAY 93
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City | RONAN
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State | MT
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Zip | 59864-2702
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Country | US
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Telephone | 406-676-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 33852 ICE HOUSE LN
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City | POLSON
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State | MT
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Zip | 59860-8186
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Country | US
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Telephone | 406-207-2955
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Fax |
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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 | DEN-DEN-LIC-9672
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License Number State | MT
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