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1013124056 NPI number — THE CENTER FOR DENTAL EXCELLENCE, S.C.

NPI Number: 1013124056
Health Care Provider/Practitioner: THE CENTER FOR DENTAL EXCELLENCE, S.C.

Information about “1013124056” NPI (THE CENTER FOR DENTAL EXCELLENCE, S.C.) exists in 1013124056 in HTML format HTML  |  1013124056 in plain Text format TXT  |  1013124056 in PDF (Portable Document Format) PDF  |  1013124056 in an XML format XML  formats.

NPI Number : 1013124056 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013124056",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE CENTER FOR DENTAL EXCELLENCE, S.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "410 SECURITY BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREEN BAY",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54313-9705",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-662-1440",
    "MailingAddressFaxNumber": "920-662-1443",
    "FirstLinePracticeLocationAddress": "410 SECURITY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREEN BAY",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54313-9705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-662-1440",
    "PracticeLocationAddressFaxNumber": "920-662-1443",
    "EnumerationDate": "05/17/2007",
    "LastUpdateDate": "03/24/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRUSKY",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": "J.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.D.S.",
    "AuthorizedOfficialTelephoneNumber": "920-662-1440",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "4498-015",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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