NPI Code Detail JSON Logo

1417293739 NPI number — IMPLANT DENTISTRY ASSOCIATES P.C.

NPI Number: 1417293739
Health Care Provider/Practitioner: IMPLANT DENTISTRY ASSOCIATES P.C.

Information about “1417293739” NPI (IMPLANT DENTISTRY ASSOCIATES P.C.) exists in 1417293739 in HTML format HTML  |  1417293739 in plain Text format TXT  |  1417293739 in PDF (Portable Document Format) PDF  |  1417293739 in an XML format XML  formats.

NPI Number : 1417293739 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417293739",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMPLANT DENTISTRY ASSOCIATES P.C.",
    "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": "234 MALL BLVD",
    "SecondLineMailingAddress": "SUITE 180",
    "MailingAddressCityName": "KING OF PRUSSIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19406-2954",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "484-231-1177",
    "MailingAddressFaxNumber": "484-231-8964",
    "FirstLinePracticeLocationAddress": "234 MALL BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 180",
    "PracticeLocationAddressCityName": "KING OF PRUSSIA",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19406-2954",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "484-231-1177",
    "PracticeLocationAddressFaxNumber": "484-231-8964",
    "EnumerationDate": "12/13/2012",
    "LastUpdateDate": "12/17/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GRATZ",
    "AuthorizedOfficialFirstName": "CLIFFORD",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "484-231-1177",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223P0700X",
          "TaxonomyName": "Prosthodontics",
          "LicenseNumber": "DS027440L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0300X",
          "TaxonomyName": "Periodontics",
          "LicenseNumber": "DS024390L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "DS035811L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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