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1639416183 NPI number — JESSICA R SWOBODA DDS,MSD

NPI Number: 1639416183
Health Care Provider/Practitioner: JESSICA R SWOBODA DDS,MSD

Information about “1639416183” NPI (JESSICA R SWOBODA DDS,MSD) exists in 1639416183 in HTML format HTML  |  1639416183 in plain Text format TXT  |  1639416183 in PDF (Portable Document Format) PDF  |  1639416183 in an XML format XML  formats.

NPI Number : 1639416183 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639416183",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SWOBODA",
    "FirstName": "JESSICA",
    "MiddleName": "R",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS,MSD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10050 NE 10TH ST # STC",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELLEVUE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98004-4121",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "452-455-2020",
    "MailingAddressFaxNumber": "425-455-0310",
    "FirstLinePracticeLocationAddress": "10050 NE 10TH ST # STC",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELLEVUE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98004-4121",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "452-455-2020",
    "PracticeLocationAddressFaxNumber": "425-455-0310",
    "EnumerationDate": "01/03/2013",
    "LastUpdateDate": "01/03/2013",
    "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": "1223P0300X",
        "TaxonomyName": "Periodontics",
        "LicenseNumber": "00010111",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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