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1689792715 NPI number — HADDONFIELD DENTAL ASSOC., LLC

NPI Number: 1689792715
Health Care Provider/Practitioner: HADDONFIELD DENTAL ASSOC., LLC

Information about “1689792715” NPI (HADDONFIELD DENTAL ASSOC., LLC) exists in 1689792715 in HTML format HTML  |  1689792715 in plain Text format TXT  |  1689792715 in PDF (Portable Document Format) PDF  |  1689792715 in an XML format XML  formats.

NPI Number : 1689792715 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689792715",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HADDONFIELD DENTAL ASSOC., LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "63 KRESSON RD STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHERRY HILL",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08034-3200",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-857-0400",
    "MailingAddressFaxNumber": "856-216-0779",
    "FirstLinePracticeLocationAddress": "63 KRESSON RD STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHERRY HILL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08034-3200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-857-0400",
    "PracticeLocationAddressFaxNumber": "856-216-0779",
    "EnumerationDate": "03/27/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REED",
    "AuthorizedOfficialFirstName": "JOHANNA",
    "AuthorizedOfficialMiddleName": "P",
    "AuthorizedOfficialTitle": "TREASURER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "856-857-0400",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DI019404",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "DI019194",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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