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1114225141 NPI number — FREDERICK P WALDSCHMIDT D.D.S.

NPI Number: 1114225141
Health Care Provider/Practitioner: FREDERICK P WALDSCHMIDT D.D.S.

Information about “1114225141” NPI (FREDERICK P WALDSCHMIDT D.D.S.) exists in 1114225141 in HTML format HTML  |  1114225141 in plain Text format TXT  |  1114225141 in PDF (Portable Document Format) PDF  |  1114225141 in an XML format XML  formats.

NPI Number : 1114225141 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114225141",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALDSCHMIDT",
    "FirstName": "FREDERICK",
    "MiddleName": "P",
    "NamePrefix": null,
    "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": "750 ALMAR PKWY",
    "SecondLineMailingAddress": "SUITE 101",
    "MailingAddressCityName": "BOURBONNAIS",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60914-2315",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-932-5221",
    "MailingAddressFaxNumber": "815-932-5269",
    "FirstLinePracticeLocationAddress": "750 ALMAR PKWY",
    "SecondLinePracticeLocationAddress": "SUITE 101",
    "PracticeLocationAddressCityName": "BOURBONNAIS",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60914-2315",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-932-5221",
    "PracticeLocationAddressFaxNumber": "815-932-5269",
    "EnumerationDate": "02/28/2011",
    "LastUpdateDate": "04/21/2015",
    "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": "019-019355",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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