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1003895368 NPI number — BRETT RAYMOND LANGSTON DMD

NPI Number: 1003895368
Health Care Provider/Practitioner: BRETT RAYMOND LANGSTON DMD

Information about “1003895368” NPI (BRETT RAYMOND LANGSTON DMD) exists in 1003895368 in HTML format HTML  |  1003895368 in plain Text format TXT  |  1003895368 in PDF (Portable Document Format) PDF  |  1003895368 in an XML format XML  formats.

NPI Number : 1003895368 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003895368",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LANGSTON",
    "FirstName": "BRETT",
    "MiddleName": "RAYMOND",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1991 N WILLIAMSBURG DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DECATUR",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30033-3500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-877-6526",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1991 N WILLIAMSBURG DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30033-3500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-877-6526",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/13/2006",
    "LastUpdateDate": "05/11/2012",
    "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": "DN01311",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223P0700X",
          "TaxonomyName": "Prosthodontics",
          "LicenseNumber": "DN013111",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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