NPI Code Detail JSON Logo

1558080804 NPI number — SPROUT PEDIATRIC DENTAL

NPI Number: 1558080804
Health Care Provider/Practitioner: SPROUT PEDIATRIC DENTAL

Information about “1558080804” NPI (SPROUT PEDIATRIC DENTAL) exists in 1558080804 in HTML format HTML  |  1558080804 in plain Text format TXT  |  1558080804 in PDF (Portable Document Format) PDF  |  1558080804 in an XML format XML  formats.

NPI Number : 1558080804 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558080804",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SPROUT PEDIATRIC DENTAL",
    "ParentOrgTIN": null,
    "OrgName": "SPROUT PEDIATRIC DENTAL",
    "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": "554 HAMLIN HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE ARIEL",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18436-9319",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "267-324-7933",
    "MailingAddressFaxNumber": "570-352-3395",
    "FirstLinePracticeLocationAddress": "541 PIERCE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KINGSTON",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "18704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "267-324-7933",
    "PracticeLocationAddressFaxNumber": "570-352-3395",
    "EnumerationDate": "08/22/2022",
    "LastUpdateDate": "03/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCHLOESSER",
    "AuthorizedOfficialFirstName": "KATHERINE",
    "AuthorizedOfficialMiddleName": "ROSALIE",
    "AuthorizedOfficialTitle": "PEDIATRIC DENTIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DMD",
    "AuthorizedOfficialTelephoneNumber": "570-253-0358",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223P0221X",
        "TaxonomyName": "Pediatric 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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