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1265574685 NPI number — ALPHONZO LOWELL DAVIDSON JR. D.D.S.

NPI Number: 1265574685
Health Care Provider/Practitioner: ALPHONZO LOWELL DAVIDSON JR. D.D.S.

Information about “1265574685” NPI (ALPHONZO LOWELL DAVIDSON JR. D.D.S.) exists in 1265574685 in HTML format HTML  |  1265574685 in plain Text format TXT  |  1265574685 in PDF (Portable Document Format) PDF  |  1265574685 in an XML format XML  formats.

NPI Number : 1265574685 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265574685",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIDSON",
    "FirstName": "ALPHONZO",
    "MiddleName": "LOWELL",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3308 SHORTRIDGE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOWIE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20721-2576",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "202-528-0440",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2811 PENNSYLVANIA AVE SE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WASHINGTON",
    "PracticeLocationAddressStateName": "DC",
    "PracticeLocationAddressPostalCode": "20020-3865",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "202-584-0710",
    "PracticeLocationAddressFaxNumber": "202-575-3627",
    "EnumerationDate": "02/13/2007",
    "LastUpdateDate": "12/22/2023",
    "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": "5474",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "11379",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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