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1548520570 NPI number — TYLER MICHAEL AHOLT DDS

NPI Number: 1548520570
Health Care Provider/Practitioner: TYLER MICHAEL AHOLT DDS

Information about “1548520570” NPI (TYLER MICHAEL AHOLT DDS) exists in 1548520570 in HTML format HTML  |  1548520570 in plain Text format TXT  |  1548520570 in PDF (Portable Document Format) PDF  |  1548520570 in an XML format XML  formats.

NPI Number : 1548520570 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548520570",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AHOLT",
    "FirstName": "TYLER",
    "MiddleName": "MICHAEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4620 HAMPTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63109-2714",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-752-7468",
    "MailingAddressFaxNumber": "314-752-5168",
    "FirstLinePracticeLocationAddress": "4620 HAMPTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63109-2714",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-752-7468",
    "PracticeLocationAddressFaxNumber": "314-752-5168",
    "EnumerationDate": "05/24/2012",
    "LastUpdateDate": "04/17/2023",
    "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": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "2012015662",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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