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1720092521 NPI number — JON J ECKHARDT DDS, MSD, ABO

NPI Number: 1720092521
Health Care Provider/Practitioner: JON J ECKHARDT DDS, MSD, ABO

Information about “1720092521” NPI (JON J ECKHARDT DDS, MSD, ABO) exists in 1720092521 in HTML format HTML  |  1720092521 in plain Text format TXT  |  1720092521 in PDF (Portable Document Format) PDF  |  1720092521 in an XML format XML  formats.

NPI Number : 1720092521 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720092521",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ECKHARDT",
    "FirstName": "JON",
    "MiddleName": "J",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS, MSD, ABO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "201 VAN GUNDY DR STE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRYAN",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43506-1179",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "419-636-5918",
    "MailingAddressFaxNumber": "419-636-0752",
    "FirstLinePracticeLocationAddress": "201 VAN GUNDY DR",
    "SecondLinePracticeLocationAddress": "STE. C",
    "PracticeLocationAddressCityName": "BRYAN",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43506-1178",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-636-5918",
    "PracticeLocationAddressFaxNumber": "419-636-0752",
    "EnumerationDate": "07/28/2006",
    "LastUpdateDate": "07/09/2007",
    "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": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "21018",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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