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1720272768 NPI number — GARDINER MCKAY PACKER D.D.S.

NPI Number: 1720272768
Health Care Provider/Practitioner: GARDINER MCKAY PACKER D.D.S.

Information about “1720272768” NPI (GARDINER MCKAY PACKER D.D.S.) exists in 1720272768 in HTML format HTML  |  1720272768 in plain Text format TXT  |  1720272768 in PDF (Portable Document Format) PDF  |  1720272768 in an XML format XML  formats.

NPI Number : 1720272768 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720272768",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PACKER",
    "FirstName": "GARDINER",
    "MiddleName": "MCKAY",
    "NamePrefix": null,
    "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": "5333 WHETSTONE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RICHMOND",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23234-4325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-743-7023",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6037 HARBOUR PARK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIDLOTHIAN",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23112-2160",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-744-3636",
    "PracticeLocationAddressFaxNumber": "804-744-6365",
    "EnumerationDate": "09/04/2007",
    "LastUpdateDate": "06/23/2009",
    "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": "1223E0200X",
        "TaxonomyName": "Endodontics",
        "LicenseNumber": "0401412190",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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