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1255083473 NPI number — SHAWN M CUSTER DENTAL PLLC

NPI Number: 1255083473
Health Care Provider/Practitioner: SHAWN M CUSTER DENTAL PLLC

Information about “1255083473” NPI (SHAWN M CUSTER DENTAL PLLC) exists in 1255083473 in HTML format HTML  |  1255083473 in plain Text format TXT  |  1255083473 in PDF (Portable Document Format) PDF  |  1255083473 in an XML format XML  formats.

NPI Number : 1255083473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255083473",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHAWN M CUSTER DENTAL PLLC",
    "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": "3950 JOHN F KENNEDY PKWY UNIT E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT COLLINS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80525-3074",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "970-732-4371",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3950 JOHN F KENNEDY PKWY UNIT E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT COLLINS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80525-3074",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "970-732-4371",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/19/2022",
    "LastUpdateDate": "01/19/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CUSTER",
    "AuthorizedOfficialFirstName": "SHAWN",
    "AuthorizedOfficialMiddleName": "MICHAEL",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "402-721-8200",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD0000X",
        "TaxonomyName": "Dental Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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