NPI Code Detail JSON Logo

1659880318 NPI number — VAIBHAV MAHESH JAGAD DMD

NPI Number: 1659880318
Health Care Provider/Practitioner: VAIBHAV MAHESH JAGAD DMD

Information about “1659880318” NPI (VAIBHAV MAHESH JAGAD DMD) exists in 1659880318 in HTML format HTML  |  1659880318 in plain Text format TXT  |  1659880318 in PDF (Portable Document Format) PDF  |  1659880318 in an XML format XML  formats.

NPI Number : 1659880318 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659880318",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JAGAD",
    "FirstName": "VAIBHAV",
    "MiddleName": "MAHESH",
    "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": "320 MIDDLESEX AVE UNIT C208",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEDFORD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02155-5084",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-995-2852",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "60 EAST ST STE 2500",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "METHUEN",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01844-4519",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-788-9303",
    "PracticeLocationAddressFaxNumber": "978-237-4003",
    "EnumerationDate": "09/26/2017",
    "LastUpdateDate": "03/26/2025",
    "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": "019031412",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DN1857831",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "DN1857831",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "019031412",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "DN1857831",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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