{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "TIMBERLAKE SHAW PLLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "4522 15TH AVE NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEATTLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98105-4507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-523-2025",
"MailingAddressFaxNumber": "206-525-6956",
"FirstLinePracticeLocationAddress": "4522 15TH AVE NE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SEATTLE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98105-4507",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-523-2025",
"PracticeLocationAddressFaxNumber": "206-525-6956",
"EnumerationDate": "08/20/2016",
"LastUpdateDate": "08/20/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAW",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "GALLAGHER",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "206-523-2025",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DE 60035235",
"LicenseNumberStateCode": "WA",
"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."
}
}
}
}