{
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"OrgName": "MAZDA BERENJIAN DDS PA",
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"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "560 DABNEY DRIVE",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "HENDERSON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27536",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-492-6004",
"MailingAddressFaxNumber": "252-492-0994",
"FirstLinePracticeLocationAddress": "560 DABNEY DRIVE",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "HENDERSON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-492-6004",
"PracticeLocationAddressFaxNumber": "252-492-0994",
"EnumerationDate": "05/29/2007",
"LastUpdateDate": "08/15/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRUMMITT",
"AuthorizedOfficialFirstName": "JAMIE",
"AuthorizedOfficialMiddleName": "M.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "252-492-6004",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "8751",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}