{
"Npi": {
"NPI": "1154696847",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KOZA FAMILY DENTAL CARE 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": "2502 COVE AVE STE D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA GRANDE",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97850-0407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-963-4962",
"MailingAddressFaxNumber": "541-963-4531",
"FirstLinePracticeLocationAddress": "2502 COVE AVE STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LA GRANDE",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97850-0407",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-963-4962",
"PracticeLocationAddressFaxNumber": "541-963-4531",
"EnumerationDate": "03/14/2012",
"LastUpdateDate": "03/14/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOZA",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "541-963-4962",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "8404",
"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."
}
}
}
}