{
"Npi": {
"NPI": "1184060501",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GENEVA DENTAL CARE",
"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": "254 S EASTON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLENSIDE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19038-3901",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-887-7788",
"MailingAddressFaxNumber": "215-887-7484",
"FirstLinePracticeLocationAddress": "254 S EASTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENSIDE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19038-3901",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-887-7788",
"PracticeLocationAddressFaxNumber": "215-887-7484",
"EnumerationDate": "05/13/2013",
"LastUpdateDate": "05/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATZULIS",
"AuthorizedOfficialFirstName": "GINNENE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS",
"AuthorizedOfficialTelephoneNumber": "215-887-7788",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DS029793L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}