1063613602 NPI number — ALAN M MELTZER DMD, M.SC.D.

NPI Number: 1063613602
Health Care Provider/Practitioner: ALAN M MELTZER DMD, M.SC.D.

NPI Number : 1063613602 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063613602",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MELTZER",
    "FirstName": "ALAN",
    "MiddleName": "M",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD, M.SC.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1307 WHITE HORSE RD",
    "SecondLineMailingAddress": "BUILDING B",
    "MailingAddressCityName": "VOORHEES",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08043-2176",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-772-9444",
    "MailingAddressFaxNumber": "856-772-2325",
    "FirstLinePracticeLocationAddress": "1307 WHITE HORSE RD",
    "SecondLinePracticeLocationAddress": "BUILDING B",
    "PracticeLocationAddressCityName": "VOORHEES",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08043-2176",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-772-9444",
    "PracticeLocationAddressFaxNumber": "856-772-2325",
    "EnumerationDate": "05/30/2007",
    "LastUpdateDate": "03/18/2019",
    "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": "1223P0300X",
          "TaxonomyName": "Periodontics",
          "LicenseNumber": "DS018710L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0300X",
          "TaxonomyName": "Periodontics",
          "LicenseNumber": "22D100923600",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}