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1699176073 NPI number — FABULOUS SMILES ORTHODONTICS, LLC

NPI Number: 1699176073
Health Care Provider/Practitioner: FABULOUS SMILES ORTHODONTICS, LLC

Information about “1699176073” NPI (FABULOUS SMILES ORTHODONTICS, LLC) exists in 1699176073 in HTML format HTML  |  1699176073 in plain Text format TXT  |  1699176073 in PDF (Portable Document Format) PDF  |  1699176073 in an XML format XML  formats.

NPI Number : 1699176073 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699176073",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FABULOUS SMILES ORTHODONTICS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3101 W INDIAN SCHOOL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85017-4035",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-861-3333",
    "MailingAddressFaxNumber": "602-682-7733",
    "FirstLinePracticeLocationAddress": "3101 W INDIAN SCHOOL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85017-4035",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-861-3333",
    "PracticeLocationAddressFaxNumber": "602-682-7733",
    "EnumerationDate": "09/04/2014",
    "LastUpdateDate": "09/04/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCOTT",
    "AuthorizedOfficialFirstName": "SHERRY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING PARTNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "480-258-1876",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "D7517",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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