{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRANDON E. DEVITO, DDS, PLLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20 MEDICAL CAMPUS DR",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "SUPPLY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28462-4096",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-755-6788",
"MailingAddressFaxNumber": "910-755-6789",
"FirstLinePracticeLocationAddress": "20 MEDICAL CAMPUS DR",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "SUPPLY",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-755-6788",
"PracticeLocationAddressFaxNumber": "910-755-6789",
"EnumerationDate": "09/25/2006",
"LastUpdateDate": "01/24/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEVITO",
"AuthorizedOfficialFirstName": "BRANDON",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "MANAGING PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "910-755-6788",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "7423",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}