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1972517217 NPI number — THERON LANE VINES JR. D.D.S.

NPI Number: 1972517217
Health Care Provider/Practitioner: THERON LANE VINES JR. D.D.S.

Information about “1972517217” NPI (THERON LANE VINES JR. D.D.S.) exists in 1972517217 in HTML format HTML  |  1972517217 in plain Text format TXT  |  1972517217 in PDF (Portable Document Format) PDF  |  1972517217 in an XML format XML  formats.

NPI Number : 1972517217 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972517217",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VINES",
    "FirstName": "THERON",
    "MiddleName": "LANE",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VINES",
    "OtherFirstName": "TERRY",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "D.D.S",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "303 BROOKSIDE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "REDLANDS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92373-4607",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-793-8837",
    "MailingAddressFaxNumber": "909-335-0497",
    "FirstLinePracticeLocationAddress": "303 BROOKSIDE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REDLANDS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92373-4607",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-793-8837",
    "PracticeLocationAddressFaxNumber": "909-335-0497",
    "EnumerationDate": "07/29/2006",
    "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": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "34009",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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