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1467422022 NPI number — STEVEN WAYNE BLACK DDS

NPI Number: 1467422022
Health Care Provider/Practitioner: STEVEN WAYNE BLACK DDS

Information about “1467422022” NPI (STEVEN WAYNE BLACK DDS) exists in 1467422022 in HTML format HTML  |  1467422022 in plain Text format TXT  |  1467422022 in PDF (Portable Document Format) PDF  |  1467422022 in an XML format XML  formats.

NPI Number : 1467422022 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467422022",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLACK",
    "FirstName": "STEVEN",
    "MiddleName": "WAYNE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLACK",
    "OtherFirstName": "STEVEN",
    "OtherMiddleName": "WAYNE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "48TH MEDICAL GROUP RAF LAKENHEATH",
    "SecondLineMailingAddress": "UNIT 5115",
    "MailingAddressCityName": "APO",
    "MailingAddressStateName": "AE",
    "MailingAddressPostalCode": "09461-5115",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "48TH MEDICAL GROUP / RAF LAKENHEATH",
    "SecondLinePracticeLocationAddress": "UNIT 5115",
    "PracticeLocationAddressCityName": "APO",
    "PracticeLocationAddressStateName": "AE",
    "PracticeLocationAddressPostalCode": "09461-5115",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "163-852-8010",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/25/2006",
    "LastUpdateDate": "09/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223E0200X",
          "TaxonomyName": "Endodontics",
          "LicenseNumber": "ENDO-526-17",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223E0200X",
          "TaxonomyName": "Endodontics",
          "LicenseNumber": "D-3652-EN",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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