{
"Npi": {
"NPI": "1144507351",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "CARROLL R. SHANKS, D.D.S., P.C.",
"ParentOrgTIN": null,
"OrgName": "CARROLL R. SHANKS, D.D.S., P.C.",
"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": "1511 E LAMAR ALEXANDER PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARYVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37804-5131",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-977-8048",
"MailingAddressFaxNumber": "865-977-0318",
"FirstLinePracticeLocationAddress": "1511 E LAMAR ALEXANDER PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARYVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37804-5131",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-977-8048",
"PracticeLocationAddressFaxNumber": "865-977-0318",
"EnumerationDate": "11/16/2011",
"LastUpdateDate": "08/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHANKS",
"AuthorizedOfficialFirstName": "CARROLL",
"AuthorizedOfficialMiddleName": "RUDOLPH",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ORAL SURGEON",
"AuthorizedOfficialTelephoneNumber": "865-977-8048",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "TN2381",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "TN2381",
"LicenseNumberStateCode": "TN",
"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."
},
{
"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."
}
]
}
}
}