{
"Npi": {
"NPI": "1073875852",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARTY R. LIPSEY, DDS, MS, INC",
"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": "3025 MCHENRY AVE",
"SecondLineMailingAddress": "SUITE N",
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95350-1466",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-527-1995",
"MailingAddressFaxNumber": "866-527-2335",
"FirstLinePracticeLocationAddress": "2421 HARTNELL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REDDING",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96002-2340",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-527-1995",
"PracticeLocationAddressFaxNumber": "866-527-2335",
"EnumerationDate": "06/08/2012",
"LastUpdateDate": "01/15/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIPSEY",
"AuthorizedOfficialFirstName": "MARTY",
"AuthorizedOfficialMiddleName": "RICHARD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S., M.S.",
"AuthorizedOfficialTelephoneNumber": "209-380-5486",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "26675",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}