{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "RICHARD L. DEVAUGHN D.D.S. INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "702 E PARK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ENID",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73701-5930",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-233-2044",
"MailingAddressFaxNumber": "580-233-1533",
"FirstLinePracticeLocationAddress": "702 E PARK ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ENID",
"PracticeLocationAddressStateName": "OK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-233-2044",
"PracticeLocationAddressFaxNumber": "580-233-1533",
"EnumerationDate": "04/23/2008",
"LastUpdateDate": "04/23/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEVAUGHN",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "L",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "580-233-2044",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "3153",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}