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1366617250 NPI number — SUBURBAN ORTHODONTICS

NPI Number: 1366617250
Health Care Provider/Practitioner: SUBURBAN ORTHODONTICS

Information about “1366617250” NPI (SUBURBAN ORTHODONTICS) exists in 1366617250 in HTML format HTML  |  1366617250 in plain Text format TXT  |  1366617250 in PDF (Portable Document Format) PDF  |  1366617250 in an XML format XML  formats.

NPI Number : 1366617250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366617250",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SUBURBAN ORTHODONTICS",
    "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": "2005 NIAGARA FALLS BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AMHERST",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14228-3520",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-568-8044",
    "MailingAddressFaxNumber": "716-649-1516",
    "FirstLinePracticeLocationAddress": "2005 NIAGARA FALLS BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMHERST",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14228-3520",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-568-8044",
    "PracticeLocationAddressFaxNumber": "716-649-1516",
    "EnumerationDate": "04/23/2008",
    "LastUpdateDate": "11/03/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BAVISOTTO",
    "AuthorizedOfficialFirstName": "ROBERT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ORTHODONTIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS",
    "AuthorizedOfficialTelephoneNumber": "716-649-5254",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "0321781",
        "LicenseNumberStateCode": "NY",
        "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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