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1134695067 NPI number — KEVIN D. DAUGHERTY, DMD AND SAVANNAH H. DAUGHERTY, DMD, PA

NPI Number: 1134695067
Health Care Provider/Practitioner: KEVIN D. DAUGHERTY, DMD AND SAVANNAH H. DAUGHERTY, DMD, PA

Information about “1134695067” NPI (KEVIN D. DAUGHERTY, DMD AND SAVANNAH H. DAUGHERTY, DMD, PA) exists in 1134695067 in HTML format HTML  |  1134695067 in plain Text format TXT  |  1134695067 in PDF (Portable Document Format) PDF  |  1134695067 in an XML format XML  formats.

NPI Number : 1134695067 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134695067",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KEVIN D. DAUGHERTY, DMD AND SAVANNAH H. DAUGHERTY, DMD, PA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1700 OLD VILLAGE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HENDERSONVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28791-3736",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "828-693-5190",
    "MailingAddressFaxNumber": "828-595-9104",
    "FirstLinePracticeLocationAddress": "1700 OLD VILLAGE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HENDERSONVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28791-3736",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-693-5190",
    "PracticeLocationAddressFaxNumber": "828-595-9104",
    "EnumerationDate": "10/18/2018",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DAUGHERTY",
    "AuthorizedOfficialFirstName": "SAVANNAH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CO OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DMD",
    "AuthorizedOfficialTelephoneNumber": "828-693-5190",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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