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1104293877 NPI number — NATHAN KING MILLER D.D.S.

NPI Number: 1104293877
Health Care Provider/Practitioner: NATHAN KING MILLER D.D.S.

Information about “1104293877” NPI (NATHAN KING MILLER D.D.S.) exists in 1104293877 in HTML format HTML  |  1104293877 in plain Text format TXT  |  1104293877 in PDF (Portable Document Format) PDF  |  1104293877 in an XML format XML  formats.

NPI Number : 1104293877 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104293877",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILLER",
    "FirstName": "NATHAN",
    "MiddleName": "KING",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2813 FIDDLEBACK ST NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LACEY",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98516-4426",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-393-4493",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "21610 PACIFIC HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OCEAN PARK",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98640-3206",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-665-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/28/2015",
    "LastUpdateDate": "03/16/2020",
    "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": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "2015018855",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "DE60938377",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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