{
"Npi": {
"NPI": "1003345216",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPRINGER DENTAL CARE OF MILLERSBURG",
"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": "3702 E MISHAWAKA RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELKHART",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46517-3550",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "574-971-1532",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "422 N BENTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILLERSBURG",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46543-9732",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "574-642-4449",
"PracticeLocationAddressFaxNumber": "574-642-3863",
"EnumerationDate": "06/09/2017",
"LastUpdateDate": "10/12/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPRINGER",
"AuthorizedOfficialFirstName": "TROY",
"AuthorizedOfficialMiddleName": "ROGER",
"AuthorizedOfficialTitle": "OWNER DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "574-971-1532",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "12011803A",
"LicenseNumberStateCode": "IN",
"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."
}
}
}
}