NPI Code Detail JSON Logo

1649091513 NPI number — CODY JOEL PEWARCHUK DMD

NPI Number: 1649091513
Health Care Provider/Practitioner: CODY JOEL PEWARCHUK DMD

Information about “1649091513” NPI (CODY JOEL PEWARCHUK DMD) exists in 1649091513 in HTML format HTML  |  1649091513 in plain Text format TXT  |  1649091513 in PDF (Portable Document Format) PDF  |  1649091513 in an XML format XML  formats.

NPI Number : 1649091513 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649091513",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PEWARCHUK",
    "FirstName": "CODY",
    "MiddleName": "JOEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13135 SHORELINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN ANTONIO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78254-6325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-793-2608",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7703 FLOYD CURL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN ANTONIO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78229-3901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-450-3700",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/22/2024",
    "LastUpdateDate": "10/22/2024",
    "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": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "ETN1084",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DEN.00206141",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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