NPI Code Detail JSON Logo

1265920086 NPI number — MARISSA BERGTHOLD DDS

NPI Number: 1265920086
Health Care Provider/Practitioner: MARISSA BERGTHOLD DDS

Information about “1265920086” NPI (MARISSA BERGTHOLD DDS) exists in 1265920086 in HTML format HTML  |  1265920086 in plain Text format TXT  |  1265920086 in PDF (Portable Document Format) PDF  |  1265920086 in an XML format XML  formats.

NPI Number : 1265920086 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265920086",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERGTHOLD",
    "FirstName": "MARISSA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7701 W 119TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OVERLAND PARK",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "66213-1103",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "913-529-5999",
    "MailingAddressFaxNumber": "913-529-5995",
    "FirstLinePracticeLocationAddress": "7701 W 119TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OVERLAND PARK",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66213-1103",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "913-529-5999",
    "PracticeLocationAddressFaxNumber": "913-529-5995",
    "EnumerationDate": "04/26/2018",
    "LastUpdateDate": "07/11/2024",
    "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": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "62193",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "2024026317",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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