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1619212966 NPI number — MARK FRANKLIN JORDAN D.D.S.

NPI Number: 1619212966
Health Care Provider/Practitioner: MARK FRANKLIN JORDAN D.D.S.

Information about “1619212966” NPI (MARK FRANKLIN JORDAN D.D.S.) exists in 1619212966 in HTML format HTML  |  1619212966 in plain Text format TXT  |  1619212966 in PDF (Portable Document Format) PDF  |  1619212966 in an XML format XML  formats.

NPI Number : 1619212966 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619212966",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JORDAN",
    "FirstName": "MARK",
    "MiddleName": "FRANKLIN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 130939",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARLSBAD",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92013-0939",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-438-0948",
    "MailingAddressFaxNumber": "760-438-7821",
    "FirstLinePracticeLocationAddress": "6120 PASEO DEL NORTE",
    "SecondLinePracticeLocationAddress": "K1",
    "PracticeLocationAddressCityName": "CARLSBAD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92011-1150",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-438-0948",
    "PracticeLocationAddressFaxNumber": "760-438-7821",
    "EnumerationDate": "11/27/2012",
    "LastUpdateDate": "11/27/2012",
    "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": "60445",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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