{
"Npi": {
"NPI": "1396074969",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRANDON M. PIPER, DMD, P.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2627 SPYGLASS CT APT D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDWARDSVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62025-3679",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-977-5245",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "469 W WOOD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DECATUR",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62522-3109",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-428-3512",
"PracticeLocationAddressFaxNumber": "217-428-3525",
"EnumerationDate": "12/10/2009",
"LastUpdateDate": "12/10/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIPER",
"AuthorizedOfficialFirstName": "BRANDON",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "618-977-5245",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "019027684",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}