{
"Npi": {
"NPI": "1205234374",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CALLEJAS",
"FirstName": "MICHAEL",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5240 DUKE ST",
"SecondLineMailingAddress": "APT 106",
"MailingAddressCityName": "ALEXANDRIA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22304-2951",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-507-9368",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14416 JEFFERSON DAVIS HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUITE 16",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22191",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-492-1999",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/05/2014",
"LastUpdateDate": "12/05/2014",
"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": "0401414549",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}