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1366234031 NPI number — KEEP MI SMILE CASSOPOLIS PC

NPI Number: 1366234031
Health Care Provider/Practitioner: KEEP MI SMILE CASSOPOLIS PC

Information about “1366234031” NPI (KEEP MI SMILE CASSOPOLIS PC) exists in 1366234031 in HTML format HTML  |  1366234031 in plain Text format TXT  |  1366234031 in PDF (Portable Document Format) PDF  |  1366234031 in an XML format XML  formats.

NPI Number : 1366234031 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366234031",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KEEP MI SMILE CASSOPOLIS PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "17 VINEWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STURGIS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49091-2375",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-651-6700",
    "MailingAddressFaxNumber": "269-659-8604",
    "FirstLinePracticeLocationAddress": "62225 M 62",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CASSOPOLIS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49031-8733",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-445-8636",
    "PracticeLocationAddressFaxNumber": "269-659-8604",
    "EnumerationDate": "05/20/2025",
    "LastUpdateDate": "05/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PLIKERD",
    "AuthorizedOfficialFirstName": "PAT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ADMINISTRATIVE",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "269-216-9298",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD0000X",
        "TaxonomyName": "Dental Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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