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1245274893 NPI number — LOUIS E ANTONACCI D.D.S

NPI Number: 1245274893
Health Care Provider/Practitioner: LOUIS E ANTONACCI D.D.S

Information about “1245274893” NPI (LOUIS E ANTONACCI D.D.S) exists in 1245274893 in HTML format HTML  |  1245274893 in plain Text format TXT  |  1245274893 in PDF (Portable Document Format) PDF  |  1245274893 in an XML format XML  formats.

NPI Number : 1245274893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245274893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANTONACCI",
    "FirstName": "LOUIS",
    "MiddleName": "E",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "519 SAWGRASS LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAMPSHIRE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60140-9678",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5301 E STATE ST",
    "SecondLinePracticeLocationAddress": "SUITE 307A",
    "PracticeLocationAddressCityName": "ROCKFORD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61108-2901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-398-0191",
    "PracticeLocationAddressFaxNumber": "815-398-0149",
    "EnumerationDate": "06/15/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": null,
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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