{
"Npi": {
"NPI": "1114204302",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE TOOTH FAIRY, 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": "21300 GOOSENECK CR. RD.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHERIDAN",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97378-9543",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-843-3348",
"MailingAddressFaxNumber": "503-843-3348",
"FirstLinePracticeLocationAddress": "21300 GOOSENECK CREEK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHERIDAN",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97378-9573",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-843-3348",
"PracticeLocationAddressFaxNumber": "503-843-3348",
"EnumerationDate": "11/16/2011",
"LastUpdateDate": "11/16/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHLOEDER",
"AuthorizedOfficialFirstName": "ELAINE",
"AuthorizedOfficialMiddleName": "V.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RDH, LAP",
"AuthorizedOfficialTelephoneNumber": "503-843-3348",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "124Q00000X",
"TaxonomyName": "Dental Hygienist",
"LicenseNumber": "H-3797",
"LicenseNumberStateCode": "OR",
"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."
}
}
}
}