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1942932108 NPI number — CORY WARNER DDS

NPI Number: 1942932108
Health Care Provider/Practitioner: CORY WARNER DDS

Information about “1942932108” NPI (CORY WARNER DDS) exists in 1942932108 in HTML format HTML  |  1942932108 in plain Text format TXT  |  1942932108 in PDF (Portable Document Format) PDF  |  1942932108 in an XML format XML  formats.

NPI Number : 1942932108 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942932108",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WARNER",
    "FirstName": "CORY",
    "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": "432 N 3900 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIGBY",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83442-5138",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-716-0375",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1801 S AMMON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMMON",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83406-6860",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-528-7665",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/27/2022",
    "LastUpdateDate": "05/25/2023",
    "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": "D011479",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "D5497",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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