{
"Npi": {
"NPI": "1114045176",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOWARD F. NEILSON DMD AND BARBARA L. NEILSON, DMD, PC",
"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": "301 W CHESTER PIKE",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "HAVERTOWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19083-4530",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-789-9400",
"MailingAddressFaxNumber": "610-789-2841",
"FirstLinePracticeLocationAddress": "301 W CHESTER PIKE",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "HAVERTOWN",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19083-4530",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-789-9400",
"PracticeLocationAddressFaxNumber": "610-789-2841",
"EnumerationDate": "03/27/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEILSOM",
"AuthorizedOfficialFirstName": "BARBARA",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "610-789-9400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DS021747L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}