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1780092155 NPI number — ERICA DANIELLE CROSTA D.M.D

NPI Number: 1780092155
Health Care Provider/Practitioner: ERICA DANIELLE CROSTA D.M.D

Information about “1780092155” NPI (ERICA DANIELLE CROSTA D.M.D) exists in 1780092155 in HTML format HTML  |  1780092155 in plain Text format TXT  |  1780092155 in PDF (Portable Document Format) PDF  |  1780092155 in an XML format XML  formats.

NPI Number : 1780092155 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780092155",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CROSTA",
    "FirstName": "ERICA",
    "MiddleName": "DANIELLE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.M.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROBINSON",
    "OtherFirstName": "ERICA",
    "OtherMiddleName": "DANIELLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "929 SW SIMPSON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97702-3599",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-848-6642",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "929 SW SIMPSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97702-3599",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-848-6642",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/29/2014",
    "LastUpdateDate": "01/05/2017",
    "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": "1223X0400X",
          "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
          "LicenseNumber": "D10528",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "LL-371-14",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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