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General NPI Number Information
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NPI Number | 1992586234
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Entity Type | Organization
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Legal Business Name | BELLAIRE DENTAL SUITE PLLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 6300 WEST LOOP S STE 250
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City | BELLAIRE
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State | TX
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Zip | 77401-2918
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Country | US
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Telephone | 346-618-5441
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Fax | 346-204-4160
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Provider Business Mailing Address
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Address Line | 110 E VILLA MARIA RD STE A
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City | BRYAN
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State | TX
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Zip | 77801-3147
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Country | US
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Telephone | 979-779-6146
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Fax | 979-779-6250
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINA RIVERS
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Credential | DDS
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Telephone | 817-925-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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