1356892657 NPI number — THOMAS R. MICHAELIS, D.D.S., M.D., INC, RYAN M. KRIWANEK, D.D.S., M.D.

NPI Number: 1356892657
Health Care Provider/Practitioner: THOMAS R. MICHAELIS, D.D.S., M.D., INC, RYAN M. KRIWANEK, D.D.S., M.D.

NPI Number : 1356892657 – XML Data Format

                    
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<Npi>
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		1356892657
	</NPI>
	<EntityType>
		Organization
	</EntityType>
	<ReplacementNPI/>
	<EIN/>
	<IsSoleProprietor/>
	<IsOrgSubpart>
		N
	</IsOrgSubpart>
	<ParentOrgLBN/>
	<ParentOrgTIN/>
	<OrgName>
		THOMAS R. MICHAELIS, D.D.S., M.D., INC, RYAN M. KRIWANEK, D.D.S., M.D.
	</OrgName>
	<LastName/>
	<FirstName/>
	<MiddleName/>
	<NamePrefix/>
	<NameSuffix/>
	<Credential/>
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		6
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	<OtherLastNameTypeCode/>
	<FirstLineMailingAddress>
		1401 AVOCADO AVE. SUITE 506
	</FirstLineMailingAddress>
	<SecondLineMailingAddress/>
	<MailingAddressCityName>
		NEWPORT BEACH
	</MailingAddressCityName>
	<MailingAddressStateName>
		CA
	</MailingAddressStateName>
	<MailingAddressPostalCode>
		92660
	</MailingAddressPostalCode>
	<MailingAddressCountryCode>
		US
	</MailingAddressCountryCode>
	<MailingAddressTelephoneNumber>
		949-760-1661
	</MailingAddressTelephoneNumber>
	<MailingAddressFaxNumber>
		949-760-8016
	</MailingAddressFaxNumber>
	<FirstLinePracticeLocationAddress>
		1401 AVOCADO AVE. SUITE 506
	</FirstLinePracticeLocationAddress>
	<SecondLinePracticeLocationAddress/>
	<PracticeLocationAddressCityName>
		NEWPORT BEACH
	</PracticeLocationAddressCityName>
	<PracticeLocationAddressStateName>
		CA
	</PracticeLocationAddressStateName>
	<PracticeLocationAddressPostalCode>
		92660
	</PracticeLocationAddressPostalCode>
	<PracticeLocationAddressCountryCode>
		US
	</PracticeLocationAddressCountryCode>
	<PracticeLocationAddressTelephoneNumber>
		949-760-1661
	</PracticeLocationAddressTelephoneNumber>
	<PracticeLocationAddressFaxNumber>
		949-760-8016
	</PracticeLocationAddressFaxNumber>
	<EnumerationDate>
		10/21/2016
	</EnumerationDate>
	<LastUpdateDate>
		01/23/2020
	</LastUpdateDate>
	<NPIDeactivationReasonCode/>
	<NPIDeactivationReason/>
	<NPIDeactivationDate/>
	<NPIReactivationDate/>
	<GenderCode/>
	<Gender/>
	<AuthorizedOfficialLastName>
		MICHAELIS
	</AuthorizedOfficialLastName>
	<AuthorizedOfficialFirstName>
		THOMAS
	</AuthorizedOfficialFirstName>
	<AuthorizedOfficialMiddleName>
		RAYMOND
	</AuthorizedOfficialMiddleName>
	<AuthorizedOfficialTitle>
		PARTNER
	</AuthorizedOfficialTitle>
	<AuthorizedOfficialNamePrefix>
		DR.
	</AuthorizedOfficialNamePrefix>
	<AuthorizedOfficialNameSuffix/>
	<AuthorizedOfficialCredential>
		DDS, MD
	</AuthorizedOfficialCredential>
	<AuthorizedOfficialTelephoneNumber>
		949-760-1661
	</AuthorizedOfficialTelephoneNumber>
	<Taxonomies>
		<Taxonomy>
			<TaxonomyCode>
				1223S0112X
			</TaxonomyCode>
			<TaxonomyName>
				Oral and Maxillofacial Surgery (Dentist)
			</TaxonomyName>
			<LicenseNumber>
				22313
			</LicenseNumber>
			<LicenseNumberStateCode>
				CA
			</LicenseNumberStateCode>
			<PrimaryTaxonomySwitch>
				N
			</PrimaryTaxonomySwitch>
		</Taxonomy>
		<Taxonomy>
			<TaxonomyCode>
				1223S0112X
			</TaxonomyCode>
			<TaxonomyName>
				Oral and Maxillofacial Surgery (Dentist)
			</TaxonomyName>
			<LicenseNumber>
				38855
			</LicenseNumber>
			<LicenseNumberStateCode>
				CA
			</LicenseNumberStateCode>
			<PrimaryTaxonomySwitch>
				Y
			</PrimaryTaxonomySwitch>
		</Taxonomy>
		<Taxonomy>
			<TaxonomyCode>
				1223S0112X
			</TaxonomyCode>
			<TaxonomyName>
				Oral and Maxillofacial Surgery (Dentist)
			</TaxonomyName>
			<LicenseNumber>
				42745
			</LicenseNumber>
			<LicenseNumberStateCode>
				CA
			</LicenseNumberStateCode>
			<PrimaryTaxonomySwitch>
				N
			</PrimaryTaxonomySwitch>
		</Taxonomy>
		<Taxonomy>
			<TaxonomyCode>
				1223S0112X
			</TaxonomyCode>
			<TaxonomyName>
				Oral and Maxillofacial Surgery (Dentist)
			</TaxonomyName>
			<LicenseNumber>
				58948
			</LicenseNumber>
			<LicenseNumberStateCode>
				CA
			</LicenseNumberStateCode>
			<PrimaryTaxonomySwitch>
				N
			</PrimaryTaxonomySwitch>
		</Taxonomy>
		<Taxonomy>
			<TaxonomyCode>
				204E00000X
			</TaxonomyCode>
			<TaxonomyName>
				Oral &amp; Maxillofacial Surgery (D.M.D.)
			</TaxonomyName>
			<LicenseNumber/>
			<LicenseNumberStateCode/>
			<PrimaryTaxonomySwitch>
				N
			</PrimaryTaxonomySwitch>
		</Taxonomy>
	</Taxonomies>
	<HealthcareProviderTaxonomyGroups>
		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193400000X MULTIPLE SINGLE SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
		</HealthcareProviderTaxonomyGroup>
		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193400000X MULTIPLE SINGLE SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
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		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193400000X MULTIPLE SINGLE SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
		</HealthcareProviderTaxonomyGroup>
		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193400000X MULTIPLE SINGLE SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
		</HealthcareProviderTaxonomyGroup>
		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193400000X MULTIPLE SINGLE SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
		</HealthcareProviderTaxonomyGroup>
	</HealthcareProviderTaxonomyGroups>
</Npi>

                    
                

NPI Number XSD (XML Schema Definition)

                
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