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1770906992 NPI number — JESSICA FRANCES DEFAZIO DDS

NPI Number: 1770906992
Health Care Provider/Practitioner: JESSICA FRANCES DEFAZIO DDS

Information about “1770906992” NPI (JESSICA FRANCES DEFAZIO DDS) exists in 1770906992 in HTML format HTML  |  1770906992 in plain Text format TXT  |  1770906992 in PDF (Portable Document Format) PDF  |  1770906992 in an XML format XML  formats.

NPI Number : 1770906992 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770906992",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEFAZIO",
    "FirstName": "JESSICA",
    "MiddleName": "FRANCES",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KRAVIT",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "FRANCES",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3776 DOVE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92103-3979",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-491-4003",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "345 E 24TH ST # 9W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10010-4020",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-491-4003",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/23/2014",
    "LastUpdateDate": "09/03/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "00000000000000000000",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "64173",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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