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1306379185 NPI number — MINT DENTAL CARE LTD

NPI Number: 1306379185
Health Care Provider/Practitioner: MINT DENTAL CARE LTD

Information about “1306379185” NPI (MINT DENTAL CARE LTD) exists in 1306379185 in HTML format HTML  |  1306379185 in plain Text format TXT  |  1306379185 in PDF (Portable Document Format) PDF  |  1306379185 in an XML format XML  formats.

NPI Number : 1306379185 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306379185",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MINT DENTAL CARE LTD",
    "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": "4635 W 63RD ST",
    "SecondLineMailingAddress": "STE D",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60629-5559",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "872-254-1008",
    "MailingAddressFaxNumber": "847-665-0416",
    "FirstLinePracticeLocationAddress": "4635 W 63RD ST",
    "SecondLinePracticeLocationAddress": "STE D",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60629-5559",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "872-254-1008",
    "PracticeLocationAddressFaxNumber": "847-665-0416",
    "EnumerationDate": "04/07/2017",
    "LastUpdateDate": "04/07/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PARK",
    "AuthorizedOfficialFirstName": "HUI JUN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "872-254-1008",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "019025067",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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