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1558672758 NPI number — MAIN PLAZA DENTAL

NPI Number: 1558672758
Health Care Provider/Practitioner: MAIN PLAZA DENTAL

Information about “1558672758” NPI (MAIN PLAZA DENTAL) exists in 1558672758 in HTML format HTML  |  1558672758 in plain Text format TXT  |  1558672758 in PDF (Portable Document Format) PDF  |  1558672758 in an XML format XML  formats.

NPI Number : 1558672758 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558672758",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MAIN PLAZA DENTAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "312 N MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPANISH FORK",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84660-1735",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-794-9684",
    "MailingAddressFaxNumber": "801-798-9474",
    "FirstLinePracticeLocationAddress": "312 N MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPANISH FORK",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84660-1735",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-794-9684",
    "PracticeLocationAddressFaxNumber": "801-798-9474",
    "EnumerationDate": "06/23/2010",
    "LastUpdateDate": "06/23/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRERETON",
    "AuthorizedOfficialFirstName": "AVERY",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "801-794-9684",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "6947302",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "5346167",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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