{
"Npi": {
"NPI": "1164891545",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMERICAN DENTAL EXCELLENCE",
"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": "905 W 124TH AVE., SUITE #130",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTMINSTER",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80234",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-920-4900",
"MailingAddressFaxNumber": "303-920-4823",
"FirstLinePracticeLocationAddress": "905 W 124TH AVE STE 130",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTMINSTER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80234-1718",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-920-4900",
"PracticeLocationAddressFaxNumber": "303-920-4823",
"EnumerationDate": "09/16/2015",
"LastUpdateDate": "09/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POLKE",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "JEFFERY",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "303-920-4900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "7878",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}