{
"Npi": {
"NPI": "1174869093",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "C. H. HILLS DENTAL, INC",
"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": "10151 MONTGOMERY BLVD NE",
"SecondLineMailingAddress": "BLD 3 SUITE B",
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87111-3670",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-275-1663",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1105 GOLF COURSE RD SE",
"SecondLinePracticeLocationAddress": "BLD A",
"PracticeLocationAddressCityName": "RIO RANCHO",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87124-4733",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-891-3190",
"PracticeLocationAddressFaxNumber": "505-994-2053",
"EnumerationDate": "12/20/2012",
"LastUpdateDate": "12/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONTOYA",
"AuthorizedOfficialFirstName": "FRANK",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "505-275-1663",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DD1561",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}