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1730329509 NPI number — FLORIDA INSTITUTE OF OROFACIAL MYOLOGY, LLC

NPI Number: 1730329509
Health Care Provider/Practitioner: FLORIDA INSTITUTE OF OROFACIAL MYOLOGY, LLC

Information about “1730329509” NPI (FLORIDA INSTITUTE OF OROFACIAL MYOLOGY, LLC) exists in 1730329509 in HTML format HTML  |  1730329509 in plain Text format TXT  |  1730329509 in PDF (Portable Document Format) PDF  |  1730329509 in an XML format XML  formats.

NPI Number : 1730329509 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730329509",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FLORIDA INSTITUTE OF OROFACIAL MYOLOGY, 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": "6059 SABAL CREEK BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ORANGE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32128-7136",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-846-8956",
    "MailingAddressFaxNumber": "603-687-4663",
    "FirstLinePracticeLocationAddress": "3930 S NOVA RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT ORANGE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32127-9281",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-846-8956",
    "PracticeLocationAddressFaxNumber": "603-687-4663",
    "EnumerationDate": "03/05/2009",
    "LastUpdateDate": "03/05/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THOMPSON",
    "AuthorizedOfficialFirstName": "BETH",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RDH, MFT",
    "AuthorizedOfficialTelephoneNumber": "386-846-8956",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD0000X",
        "TaxonomyName": "Dental Clinic/Center",
        "LicenseNumber": "8897",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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