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1972721165 NPI number — JOHN A BENKOVICH III DDS, MS

NPI Number: 1972721165
Health Care Provider/Practitioner: JOHN A BENKOVICH III DDS, MS

Information about “1972721165” NPI (JOHN A BENKOVICH III DDS, MS) exists in 1972721165 in HTML format HTML  |  1972721165 in plain Text format TXT  |  1972721165 in PDF (Portable Document Format) PDF  |  1972721165 in an XML format XML  formats.

NPI Number : 1972721165 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972721165",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BENKOVICH",
    "FirstName": "JOHN",
    "MiddleName": "A",
    "NamePrefix": "DR.",
    "NameSuffix": "III",
    "Credential": "DDS, MS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1616 FOREST DR",
    "SecondLineMailingAddress": "SUITE 7",
    "MailingAddressCityName": "ANNAPOLIS",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-268-1700",
    "MailingAddressFaxNumber": "410-295-7243",
    "FirstLinePracticeLocationAddress": "800 ABRUZZI DRIVE UNIT F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESTER",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21619",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-268-1700",
    "PracticeLocationAddressFaxNumber": "410-295-7243",
    "EnumerationDate": "04/23/2007",
    "LastUpdateDate": "06/25/2020",
    "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": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "10906",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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