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1700566551 NPI number — BRANDON MICHAEL WILBURN DMD

NPI Number: 1700566551
Health Care Provider/Practitioner: BRANDON MICHAEL WILBURN DMD

Information about “1700566551” NPI (BRANDON MICHAEL WILBURN DMD) exists in 1700566551 in HTML format HTML  |  1700566551 in plain Text format TXT  |  1700566551 in PDF (Portable Document Format) PDF  |  1700566551 in an XML format XML  formats.

NPI Number : 1700566551 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700566551",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILBURN",
    "FirstName": "BRANDON",
    "MiddleName": "MICHAEL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3313 N PIONEER CANYON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIDGEFIELD",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98642-8034",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-679-7517",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1300 ESTHER ST STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98660-2890",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-693-4701",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/18/2023",
    "LastUpdateDate": "07/18/2023",
    "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": "1223P0700X",
        "TaxonomyName": "Prosthodontics",
        "LicenseNumber": "DE61433639",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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