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1003984360 NPI number — ANGELA MARIE DAVIS DDS

NPI Number: 1003984360
Health Care Provider/Practitioner: ANGELA MARIE DAVIS DDS

Information about “1003984360” NPI (ANGELA MARIE DAVIS DDS) exists in 1003984360 in HTML format HTML  |  1003984360 in plain Text format TXT  |  1003984360 in PDF (Portable Document Format) PDF  |  1003984360 in an XML format XML  formats.

NPI Number : 1003984360 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003984360",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "ANGELA",
    "MiddleName": "MARIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "35 DANNER CT APT 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38103-5990",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-529-1061",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "306 N 6TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST MEMPHIS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72301-3221",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-732-2107",
    "PracticeLocationAddressFaxNumber": "870-732-8843",
    "EnumerationDate": "12/02/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "3553",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "8442",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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