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1992864375 NPI number — MICHAEL W GRANGER DMD

NPI Number: 1992864375
Health Care Provider/Practitioner: MICHAEL W GRANGER DMD

Information about “1992864375” NPI (MICHAEL W GRANGER DMD) exists in 1992864375 in HTML format HTML  |  1992864375 in plain Text format TXT  |  1992864375 in PDF (Portable Document Format) PDF  |  1992864375 in an XML format XML  formats.

NPI Number : 1992864375 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992864375",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRANGER",
    "FirstName": "MICHAEL",
    "MiddleName": "W",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GRANGER",
    "OtherFirstName": "MICHAEL",
    "OtherMiddleName": "WADE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "745 BRADLEY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30214-2030",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-461-4142",
    "MailingAddressFaxNumber": "770-719-8862",
    "FirstLinePracticeLocationAddress": "745 BRADLEY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30214-2030",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-461-4142",
    "PracticeLocationAddressFaxNumber": "770-719-8862",
    "EnumerationDate": "12/08/2006",
    "LastUpdateDate": "07/09/2012",
    "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": "1223X0400X",
        "TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
        "LicenseNumber": "011413",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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