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1497347686 NPI number — RENEWAL FAMILY DENTAL PLLC

NPI Number: 1497347686
Health Care Provider/Practitioner: RENEWAL FAMILY DENTAL PLLC

Information about “1497347686” NPI (RENEWAL FAMILY DENTAL PLLC) exists in 1497347686 in HTML format HTML  |  1497347686 in plain Text format TXT  |  1497347686 in PDF (Portable Document Format) PDF  |  1497347686 in an XML format XML  formats.

NPI Number : 1497347686 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497347686",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RENEWAL FAMILY DENTAL PLLC",
    "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": "600 RIDGEMONT AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEARBORN",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48124-1221",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-213-2505",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "22190 GARRISON ST STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DEARBORN",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48124-2235",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-277-8900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/09/2021",
    "LastUpdateDate": "02/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GAGNON-SALEEBY",
    "AuthorizedOfficialFirstName": "SABAH",
    "AuthorizedOfficialMiddleName": "LILLIAN",
    "AuthorizedOfficialTitle": "DENTIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS",
    "AuthorizedOfficialTelephoneNumber": "313-213-2505",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "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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