{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ANDREW J. DIETZ, DDS, PA",
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"FirstLineMailingAddress": "17 WHITE HORSE PIKE",
"SecondLineMailingAddress": "SUITE 8",
"MailingAddressCityName": "HADDON HEIGHTS",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08035-1299",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-547-8664",
"MailingAddressFaxNumber": "856-547-5560",
"FirstLinePracticeLocationAddress": "17 WHITE HORSE PIKE",
"SecondLinePracticeLocationAddress": "SUITE 8",
"PracticeLocationAddressCityName": "HADDON HEIGHTS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-547-8664",
"PracticeLocationAddressFaxNumber": "856-547-5560",
"EnumerationDate": "11/02/2012",
"LastUpdateDate": "11/02/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIETZ",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "856-547-8664",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0700X",
"TaxonomyName": "Prosthodontics",
"LicenseNumber": "22DI01814600",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}