1871615658 NPI number — MARK J ELMORE I D.D.S.,P.S.

NPI Number: 1871615658
Health Care Provider/Practitioner: MARK J ELMORE I D.D.S.,P.S.

NPI Number : 1871615658 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871615658",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELMORE",
    "FirstName": "MARK",
    "MiddleName": "J",
    "NamePrefix": "DR.",
    "NameSuffix": "I",
    "Credential": "D.D.S.,P.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ELMORE",
    "OtherFirstName": "MARK",
    "OtherMiddleName": "J.",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "803 39TH AVE SW",
    "SecondLineMailingAddress": "SUITE A",
    "MailingAddressCityName": "PUYALLUP",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98373-3692",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-841-1529",
    "MailingAddressFaxNumber": "253-841-7853",
    "FirstLinePracticeLocationAddress": "803 39TH AVE SW",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "PUYALLUP",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98373-3692",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-841-1529",
    "PracticeLocationAddressFaxNumber": "253-841-7853",
    "EnumerationDate": "04/04/2007",
    "LastUpdateDate": "07/08/2007",
    "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": null,
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}