{
"Npi": {
"NPI": "1164693263",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CLEMENT",
"FirstName": "CHAD",
"MiddleName": "ELLIOTT",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CLEMENT",
"OtherFirstName": "CHAD",
"OtherMiddleName": "ELLIOTT",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.D.S.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 1487",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLORENCE",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97439-0075",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-997-3423",
"MailingAddressFaxNumber": "541-997-8749",
"FirstLinePracticeLocationAddress": "1256 BAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLORENCE",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97439-9648",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-997-3423",
"PracticeLocationAddressFaxNumber": "541-997-8749",
"EnumerationDate": "03/17/2008",
"LastUpdateDate": "12/31/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "D8497",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}