{
"Npi": {
"NPI": "1053578260",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "OVERHOLSER",
"FirstName": "SCOTT",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.D.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3115 N BROADWAY ST",
"SecondLineMailingAddress": "LAKEVIEW DENTAL ARTS",
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60657-4522",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-270-5000",
"MailingAddressFaxNumber": "872-206-5337",
"FirstLinePracticeLocationAddress": "3115 N BROADWAY ST",
"SecondLinePracticeLocationAddress": "LAKEVIEW DENTAL ARTS",
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60657-4522",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-270-5000",
"PracticeLocationAddressFaxNumber": "872-206-5337",
"EnumerationDate": "05/16/2008",
"LastUpdateDate": "12/08/2016",
"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": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "019026260",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}