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1396276333 NPI number — DENTISTRY BY DESIGN OF JACKSON, PLC

NPI Number: 1396276333
Health Care Provider/Practitioner: DENTISTRY BY DESIGN OF JACKSON, PLC

Information about “1396276333” NPI (DENTISTRY BY DESIGN OF JACKSON, PLC) exists in 1396276333 in HTML format HTML  |  1396276333 in plain Text format TXT  |  1396276333 in PDF (Portable Document Format) PDF  |  1396276333 in an XML format XML  formats.

NPI Number : 1396276333 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396276333",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DENTISTRY BY DESIGN OF JACKSON, PLC",
    "ParentOrgTIN": null,
    "OrgName": "DENTISTRY BY DESIGN OF JACKSON, PLC",
    "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": "306 W WASHINGTON AVE STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49201-2141",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "517-787-5055",
    "MailingAddressFaxNumber": "517-787-9346",
    "FirstLinePracticeLocationAddress": "306 W WASHINGTON AVE STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49201-2141",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-787-5055",
    "PracticeLocationAddressFaxNumber": "517-787-9346",
    "EnumerationDate": "03/22/2017",
    "LastUpdateDate": "08/07/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BALAZE",
    "AuthorizedOfficialFirstName": "ANDREW",
    "AuthorizedOfficialMiddleName": "JAMES",
    "AuthorizedOfficialTitle": "DENTIST/OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.M.D.",
    "AuthorizedOfficialTelephoneNumber": "517-787-5055",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "2901020967",
          "LicenseNumberStateCode": "MI",
          "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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