{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JEFFREY D. FOWLER, D.D.S., M.ED., P.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
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"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8120 S HOLLY ST",
"SecondLineMailingAddress": "#204",
"MailingAddressCityName": "CENTENNIAL",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80122-4005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-771-6969",
"MailingAddressFaxNumber": "303-771-1082",
"FirstLinePracticeLocationAddress": "8120 S HOLLY ST",
"SecondLinePracticeLocationAddress": "#204",
"PracticeLocationAddressCityName": "CENTENNIAL",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80122-4005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-771-6969",
"PracticeLocationAddressFaxNumber": "303-771-1082",
"EnumerationDate": "05/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOWLER",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "DUANE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "303-771-6969",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0300X",
"TaxonomyName": "Periodontics",
"LicenseNumber": "7725",
"LicenseNumberStateCode": "CO",
"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."
}
}
}
}