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1073016028 NPI number — STUART W ALLYN DDS, MD

NPI Number: 1073016028
Health Care Provider/Practitioner: STUART W ALLYN DDS, MD

Information about “1073016028” NPI (STUART W ALLYN DDS, MD) exists in 1073016028 in HTML format HTML  |  1073016028 in plain Text format TXT  |  1073016028 in PDF (Portable Document Format) PDF  |  1073016028 in an XML format XML  formats.

NPI Number : 1073016028 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073016028",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ALLYN",
    "FirstName": "STUART",
    "MiddleName": "W",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS, MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "805 S RESERVE ST, MISSOULA, MT 59801",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSOULA",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "805 S RESERVE ST, MISSOULA, MT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-549-6600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/15/2018",
    "LastUpdateDate": "10/15/2024",
    "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": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "DEN-DEN-LIC-28338",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "144637",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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