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1124195185 NPI number — JOAN PHYLLIS GOLDSTEIN DDS

NPI Number: 1124195185
Health Care Provider/Practitioner: JOAN PHYLLIS GOLDSTEIN DDS

Information about “1124195185” NPI (JOAN PHYLLIS GOLDSTEIN DDS) exists in 1124195185 in HTML format HTML  |  1124195185 in plain Text format TXT  |  1124195185 in PDF (Portable Document Format) PDF  |  1124195185 in an XML format XML  formats.

NPI Number : 1124195185 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124195185",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOLDSTEIN",
    "FirstName": "JOAN",
    "MiddleName": "PHYLLIS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "55 E WASHINTON #2902",
    "SecondLineMailingAddress": "COSMETIC DENTAL CENTER OF CHICAGO PC",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60602",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-263-2447",
    "MailingAddressFaxNumber": "312-263-2158",
    "FirstLinePracticeLocationAddress": "55 E WASHINGTON",
    "SecondLinePracticeLocationAddress": "#2902",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60602",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-263-2447",
    "PracticeLocationAddressFaxNumber": "312-263-2158",
    "EnumerationDate": "11/28/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "19020341",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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