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1124183330 NPI number — KELLY HARTNETT MCDERMOTT DDS

NPI Number: 1124183330
Health Care Provider/Practitioner: KELLY HARTNETT MCDERMOTT DDS

Information about “1124183330” NPI (KELLY HARTNETT MCDERMOTT DDS) exists in 1124183330 in HTML format HTML  |  1124183330 in plain Text format TXT  |  1124183330 in PDF (Portable Document Format) PDF  |  1124183330 in an XML format XML  formats.

NPI Number : 1124183330 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124183330",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCDERMOTT",
    "FirstName": "KELLY",
    "MiddleName": "HARTNETT",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCDERMOTT",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "HARTNETT",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "111 GASLIGHT BLVD",
    "SecondLineMailingAddress": "SUITE A",
    "MailingAddressCityName": "LUFKIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75904-3188",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "936-634-8201",
    "MailingAddressFaxNumber": "936-639-2187",
    "FirstLinePracticeLocationAddress": "111 GASLIGHT BLVD",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "LUFKIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75904-3188",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "936-634-8201",
    "PracticeLocationAddressFaxNumber": "936-639-2187",
    "EnumerationDate": "12/27/2006",
    "LastUpdateDate": "09/22/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "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": "22144",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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