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1902098817 NPI number — MICHAEL C. SHUCK D.D.S.

NPI Number: 1902098817
Health Care Provider/Practitioner: MICHAEL C. SHUCK D.D.S.

Information about “1902098817” NPI (MICHAEL C. SHUCK D.D.S.) exists in 1902098817 in HTML format HTML  |  1902098817 in plain Text format TXT  |  1902098817 in PDF (Portable Document Format) PDF  |  1902098817 in an XML format XML  formats.

NPI Number : 1902098817 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902098817",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHUCK",
    "FirstName": "MICHAEL",
    "MiddleName": "C.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHUCK",
    "OtherFirstName": "MICHAEL",
    "OtherMiddleName": "C.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "D.D.S.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1480-2A QUARTERPATH ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23185",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-345-2295",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1480-2A QUARTERPATH ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILLIAMSBURG",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23185",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-345-2295",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2007",
    "LastUpdateDate": "10/18/2011",
    "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": "0401411834",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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