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1730517954 NPI number — BRAINERD AREA ORTHODONTICS, LLC

NPI Number: 1730517954
Health Care Provider/Practitioner: BRAINERD AREA ORTHODONTICS, LLC

Information about “1730517954” NPI (BRAINERD AREA ORTHODONTICS, LLC) exists in 1730517954 in HTML format HTML  |  1730517954 in plain Text format TXT  |  1730517954 in PDF (Portable Document Format) PDF  |  1730517954 in an XML format XML  formats.

NPI Number : 1730517954 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730517954",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRAINERD AREA ORTHODONTICS, 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": "13367 ISLE DR",
    "SecondLineMailingAddress": "SUITE 2",
    "MailingAddressCityName": "BAXTER",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56425-2221",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-838-2650",
    "MailingAddressFaxNumber": "218-454-2672",
    "FirstLinePracticeLocationAddress": "13367 ISLE DR",
    "SecondLinePracticeLocationAddress": "SUITE 2",
    "PracticeLocationAddressCityName": "BAXTER",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56425-2221",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-838-2650",
    "PracticeLocationAddressFaxNumber": "218-454-2672",
    "EnumerationDate": "10/25/2013",
    "LastUpdateDate": "11/13/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COLBY",
    "AuthorizedOfficialFirstName": "STEPHEN",
    "AuthorizedOfficialMiddleName": "WILLIAM",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS, MS, PA",
    "AuthorizedOfficialTelephoneNumber": "218-838-2650",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "13161",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "10906",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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