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1518670165 NPI number — KEYSTONE ORAL SURGERY ASSOCIATES PC

NPI Number: 1518670165
Health Care Provider/Practitioner: KEYSTONE ORAL SURGERY ASSOCIATES PC

Information about “1518670165” NPI (KEYSTONE ORAL SURGERY ASSOCIATES PC) exists in 1518670165 in HTML format HTML  |  1518670165 in plain Text format TXT  |  1518670165 in PDF (Portable Document Format) PDF  |  1518670165 in an XML format XML  formats.

NPI Number : 1518670165 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518670165",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KEYSTONE ORAL SURGERY ASSOCIATES PC",
    "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": "78 WINDSOR RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELLE MEAD",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08502-5851",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "267-809-2364",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "30 BALDWIN BLVD STE 95",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHAMOKIN DAM",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "17876-9520",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "570-884-8321",
    "PracticeLocationAddressFaxNumber": "570-256-1772",
    "EnumerationDate": "12/28/2022",
    "LastUpdateDate": "02/05/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REDDY",
    "AuthorizedOfficialFirstName": "PRANATHI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS",
    "AuthorizedOfficialTelephoneNumber": "570-884-8321",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223S0112X",
        "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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