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1003256272 NPI number — BRENT STEVEN DESUTTER D.D.S.

NPI Number: 1003256272
Health Care Provider/Practitioner: BRENT STEVEN DESUTTER D.D.S.

Information about “1003256272” NPI (BRENT STEVEN DESUTTER D.D.S.) exists in 1003256272 in HTML format HTML  |  1003256272 in plain Text format TXT  |  1003256272 in PDF (Portable Document Format) PDF  |  1003256272 in an XML format XML  formats.

NPI Number : 1003256272 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003256272",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DESUTTER",
    "FirstName": "BRENT",
    "MiddleName": "STEVEN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "718 N BUCKNER BLVD STE 110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75218-2764",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-295-8440",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "718 N BUCKNER BLVD STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75218-2764",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-295-8440",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/02/2013",
    "LastUpdateDate": "10/10/2017",
    "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": "32336",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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