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1780355644 NPI number — HIRVING HENRIQUEZ DDS

NPI Number: 1780355644
Health Care Provider/Practitioner: HIRVING HENRIQUEZ DDS

Information about “1780355644” NPI (HIRVING HENRIQUEZ DDS) exists in 1780355644 in HTML format HTML  |  1780355644 in plain Text format TXT  |  1780355644 in PDF (Portable Document Format) PDF  |  1780355644 in an XML format XML  formats.

NPI Number : 1780355644 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780355644",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENRIQUEZ",
    "FirstName": "HIRVING",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "82 CRYSTAL BROOK DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01118-3755",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-214-4343",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "53 FAIRVIEW ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRATTLEBORO",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05301-6630",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-490-2923",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/21/2021",
    "LastUpdateDate": "05/23/2024",
    "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": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "2023016832",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "04950",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "13751",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "016.0134056",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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