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1063575736 NPI number — WILLIAM PETER BUTRICA JR. D.D.S.

NPI Number: 1063575736
Health Care Provider/Practitioner: WILLIAM PETER BUTRICA JR. D.D.S.

Information about “1063575736” NPI (WILLIAM PETER BUTRICA JR. D.D.S.) exists in 1063575736 in HTML format HTML  |  1063575736 in plain Text format TXT  |  1063575736 in PDF (Portable Document Format) PDF  |  1063575736 in an XML format XML  formats.

NPI Number : 1063575736 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063575736",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUTRICA",
    "FirstName": "WILLIAM",
    "MiddleName": "PETER",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "990 SONOMA AVE",
    "SecondLineMailingAddress": "SUITE #22",
    "MailingAddressCityName": "SANTA ROSA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95404-4802",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-528-8400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "990 SONOMA AVE",
    "SecondLinePracticeLocationAddress": "SUITE #22",
    "PracticeLocationAddressCityName": "SANTA ROSA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95404-4802",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-528-8400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2006",
    "LastUpdateDate": "03/04/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "B42036",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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