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1720016900 NPI number — ROYAL ELLINGER D.D.S.

NPI Number: 1720016900
Health Care Provider/Practitioner: ROYAL ELLINGER D.D.S.

Information about “1720016900” NPI (ROYAL ELLINGER D.D.S.) exists in 1720016900 in HTML format HTML  |  1720016900 in plain Text format TXT  |  1720016900 in PDF (Portable Document Format) PDF  |  1720016900 in an XML format XML  formats.

NPI Number : 1720016900 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720016900",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLINGER",
    "FirstName": "ROYAL",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7995 W LAKE POINTE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRANKLIN",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53132-8529",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-384-2000",
    "MailingAddressFaxNumber": "414-389-4162",
    "FirstLinePracticeLocationAddress": "MILWAUKEE VA MEDICAL CENTER / DENTAL CLINIC",
    "SecondLinePracticeLocationAddress": "5000 NATIONAL AVE",
    "PracticeLocationAddressCityName": "MILWAUKEE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53295-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-384-2000",
    "PracticeLocationAddressFaxNumber": "414-389-4162",
    "EnumerationDate": "06/28/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "1223P0300X",
        "TaxonomyName": "Periodontics",
        "LicenseNumber": "5001965",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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