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1154624401 NPI number — PEDIATRIC DENTAL SPECIALIST OF NEW MEXICO LLC

NPI Number: 1154624401
Health Care Provider/Practitioner: PEDIATRIC DENTAL SPECIALIST OF NEW MEXICO LLC

Information about “1154624401” NPI (PEDIATRIC DENTAL SPECIALIST OF NEW MEXICO LLC) exists in 1154624401 in HTML format HTML  |  1154624401 in plain Text format TXT  |  1154624401 in PDF (Portable Document Format) PDF  |  1154624401 in an XML format XML  formats.

NPI Number : 1154624401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154624401",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEDIATRIC DENTAL SPECIALIST OF NEW MEXICO LLC",
    "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": "5475 REMINGTON ROAD",
    "SecondLineMailingAddress": "DR. PETER HAYES",
    "MailingAddressCityName": "LAS CRUCES",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88011-7594",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "575-621-0800",
    "MailingAddressFaxNumber": "575-373-3091",
    "FirstLinePracticeLocationAddress": "2450 SOUTH TELSHOR",
    "SecondLinePracticeLocationAddress": "MEMORIAL MEDICAL HOSPITAL",
    "PracticeLocationAddressCityName": "LAS CRUCES",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "88011-7594",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "575-621-0800",
    "PracticeLocationAddressFaxNumber": "575-373-3091",
    "EnumerationDate": "12/08/2010",
    "LastUpdateDate": "12/08/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HAYES",
    "AuthorizedOfficialFirstName": "PETER",
    "AuthorizedOfficialMiddleName": "ANDREW",
    "AuthorizedOfficialTitle": "PEDIATRIC DENTAL SPECIALIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DMD, MS.",
    "AuthorizedOfficialTelephoneNumber": "575-621-0800",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DD2233",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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