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1215509476 NPI number — CARLY KOUTROPOULOS D.M.D.

NPI Number: 1215509476
Health Care Provider/Practitioner: CARLY KOUTROPOULOS D.M.D.

Information about “1215509476” NPI (CARLY KOUTROPOULOS D.M.D.) exists in 1215509476 in HTML format HTML  |  1215509476 in plain Text format TXT  |  1215509476 in PDF (Portable Document Format) PDF  |  1215509476 in an XML format XML  formats.

NPI Number : 1215509476 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215509476",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOUTROPOULOS",
    "FirstName": "CARLY",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COLBY",
    "OtherFirstName": "CARLYE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "D.M.D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1423 MICAHS WAY N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRING LAKE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28390-2869",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-713-5637",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "GRUBER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT BRAGG",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28310-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-396-1572",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/15/2021",
    "LastUpdateDate": "10/28/2025",
    "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": "12013686A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "12013686A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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