{
"Npi": {
"NPI": "1023028891",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FLYNN",
"FirstName": "KEITH",
"MiddleName": "BRYAN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1505 REDBANK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GOOSE CREEK",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-824-8742",
"MailingAddressFaxNumber": "843-824-8430",
"FirstLinePracticeLocationAddress": "1505 REDBANK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GOOSE CREEK",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29445",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-824-8742",
"PracticeLocationAddressFaxNumber": "843-824-8430",
"EnumerationDate": "08/08/2006",
"LastUpdateDate": "07/08/2007",
"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": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "SC3106",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}