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1861133365 NPI number — MAYA SIMONE WHITE DDS

NPI Number: 1861133365
Health Care Provider/Practitioner: MAYA SIMONE WHITE DDS

Information about “1861133365” NPI (MAYA SIMONE WHITE DDS) exists in 1861133365 in HTML format HTML  |  1861133365 in plain Text format TXT  |  1861133365 in PDF (Portable Document Format) PDF  |  1861133365 in an XML format XML  formats.

NPI Number : 1861133365 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861133365",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WHITE",
    "FirstName": "MAYA",
    "MiddleName": "SIMONE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WHITE",
    "OtherFirstName": "MAYA",
    "OtherMiddleName": "SIMONE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "8179 MCGREGOR XING",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OLIVE BRANCH",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "38654-1408",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "662-408-3352",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8179 MCGREGOR XING",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OLIVE BRANCH",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "38654-1408",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-408-3352",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/06/2022",
    "LastUpdateDate": "08/01/2024",
    "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": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "12018",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "4472-24",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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