NPI Code Detail JSON Logo

1629241161 NPI number — SANDRA G FISHER DDS

NPI Number: 1629241161
Health Care Provider/Practitioner: SANDRA G FISHER DDS

Information about “1629241161” NPI (SANDRA G FISHER DDS) exists in 1629241161 in HTML format HTML  |  1629241161 in plain Text format TXT  |  1629241161 in PDF (Portable Document Format) PDF  |  1629241161 in an XML format XML  formats.

NPI Number : 1629241161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629241161",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FISHER",
    "FirstName": "SANDRA",
    "MiddleName": "G",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GRABOWSKI",
    "OtherFirstName": "SANDRA",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "191 WILDWOOD ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE FOREST",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60045",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-778-3196",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4235 W NORTH AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60639",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-276-3360",
    "PracticeLocationAddressFaxNumber": "773-276-4032",
    "EnumerationDate": "04/04/2008",
    "LastUpdateDate": "04/04/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "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": "01924466",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "09292",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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