{
"Npi": {
"NPI": "1144379546",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR. TERRY SCOTESE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9179 MENTOR AVE UNIT K",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENTOR",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44060-6398",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-205-1222",
"MailingAddressFaxNumber": "440-974-5474",
"FirstLinePracticeLocationAddress": "9179 MENTOR AVE UNIT K",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MENTOR",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44060-6398",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "440-205-1222",
"PracticeLocationAddressFaxNumber": "440-974-5474",
"EnumerationDate": "01/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCOTESE",
"AuthorizedOfficialFirstName": "TERRY",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.,M.S.D.",
"AuthorizedOfficialTelephoneNumber": "440-205-1222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "30-01-6248",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}