{
"Npi": {
"NPI": "1386054013",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRETT B. MELGOSA DMD INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "700 CRANE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TURLOCK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95380-4546",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-634-5858",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "700 CRANE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TURLOCK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95380-4546",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-634-5858",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/02/2014",
"LastUpdateDate": "05/02/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MELGOSA",
"AuthorizedOfficialFirstName": "BRETT",
"AuthorizedOfficialMiddleName": "BREINIG",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D",
"AuthorizedOfficialTelephoneNumber": "209-634-5858",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "61429",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}