{
"Npi": {
"NPI": "1912048828",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VERNON E. O'BERRY JR. DDS PC",
"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": "400 GRESHAM DR.",
"SecondLineMailingAddress": "SUITE 708",
"MailingAddressCityName": "NORFOLK",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23507-1234",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-627-1882",
"MailingAddressFaxNumber": "757-627-7807",
"FirstLinePracticeLocationAddress": "400 GRESHAM DR",
"SecondLinePracticeLocationAddress": "SUITE 708",
"PracticeLocationAddressCityName": "NORFOLK",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23507-1901",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-627-1882",
"PracticeLocationAddressFaxNumber": "757-627-7807",
"EnumerationDate": "02/12/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "O'BERRY",
"AuthorizedOfficialFirstName": "VERNON",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "757-627-1882",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "6196",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}