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1063829877 NPI number — JESSE O. ROSARIO DMD

NPI Number: 1063829877
Health Care Provider/Practitioner: JESSE O. ROSARIO DMD

Information about “1063829877” NPI (JESSE O. ROSARIO DMD) exists in 1063829877 in HTML format HTML  |  1063829877 in plain Text format TXT  |  1063829877 in PDF (Portable Document Format) PDF  |  1063829877 in an XML format XML  formats.

NPI Number : 1063829877 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063829877",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROSARIO",
    "FirstName": "JESSE",
    "MiddleName": "O.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HERNANDEZ",
    "OtherFirstName": "JESSE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2383 BARONSMEDE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINTER GARDEN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34787-4680",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1475 6TH ST NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WINTER HAVEN",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33881-2365",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "863-226-0261",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/14/2014",
    "LastUpdateDate": "01/08/2025",
    "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": "1223E0200X",
        "TaxonomyName": "Endodontics",
        "LicenseNumber": "DN20791",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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