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1245599703 NPI number — JOHN J KEATING IV DMD

NPI Number: 1245599703
Health Care Provider/Practitioner: JOHN J KEATING IV DMD

Information about “1245599703” NPI (JOHN J KEATING IV DMD) exists in 1245599703 in HTML format HTML  |  1245599703 in plain Text format TXT  |  1245599703 in PDF (Portable Document Format) PDF  |  1245599703 in an XML format XML  formats.

NPI Number : 1245599703 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245599703",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEATING",
    "FirstName": "JOHN",
    "MiddleName": "J",
    "NamePrefix": "DR.",
    "NameSuffix": "IV",
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3821 W PUEBLO BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUEBLO",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "81005-2713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3821 W PUEBLO BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUEBLO",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "81005-2713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-564-6467",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/03/2012",
    "LastUpdateDate": "03/17/2018",
    "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": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "22DI02497500",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223X0400X",
          "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
          "LicenseNumber": "DEN.00203355",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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