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1801363247 NPI number — BRE'ON MONIQUE ANDERSON DDS

NPI Number: 1801363247
Health Care Provider/Practitioner: BRE'ON MONIQUE ANDERSON DDS

Information about “1801363247” NPI (BRE'ON MONIQUE ANDERSON DDS) exists in 1801363247 in HTML format HTML  |  1801363247 in plain Text format TXT  |  1801363247 in PDF (Portable Document Format) PDF  |  1801363247 in an XML format XML  formats.

NPI Number : 1801363247 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801363247",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANDERSON",
    "FirstName": "BRE'ON",
    "MiddleName": "MONIQUE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5798 OGEECHEE RD APT 1021",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAVANNAH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31405-9544",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "504-908-4188",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "319 W GENERAL SCREVEN WAY STE H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HINESVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31313-3065",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-368-6881",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/24/2018",
    "LastUpdateDate": "10/24/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "DN015764",
        "LicenseNumberStateCode": "GA",
        "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."
      }
    }
  }
}
                
            

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