{
"Npi": {
"NPI": "1174751531",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENTAL ASSOCIATES, LTD.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1247",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIRGINIA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55792-1247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-741-9251",
"MailingAddressFaxNumber": "218-741-1747",
"FirstLinePracticeLocationAddress": "108 N 3RD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VIRGINIA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55792-2519",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-741-9251",
"PracticeLocationAddressFaxNumber": "218-741-1747",
"EnumerationDate": "06/24/2009",
"LastUpdateDate": "06/24/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GODMARE",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "218-741-9251",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "D9169",
"LicenseNumberStateCode": "MN",
"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."
}
}
}
}