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General NPI Number Information
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NPI Number | 1972936037
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Entity Type | Organization
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Legal Business Name | RONALD L RECEVEUR DDS LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 819 MOUNT TABOR RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-6414
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Country | US
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Telephone | 812-948-2281
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Fax |
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Provider Business Mailing Address
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Address Line | 819 MOUNT TABOR RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-6414
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Country | US
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Telephone | 812-948-2281
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. RONALD LEO RECEVEUR
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Credential | DDS
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Telephone | 812-948-2281
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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 | 12008027
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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