{
"Npi": {
"NPI": "1205731320",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOUNTAIN SMILES - DSS PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "713 W BAILEY BOSWELL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAGINAW",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76179-1031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-847-4040",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "713 W BAILEY BOSWELL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAGINAW",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76179-1031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-847-4040",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/09/2026",
"LastUpdateDate": "10/09/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIMENEZ",
"AuthorizedOfficialFirstName": "ANGEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "719-300-5933",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223E0200X",
"TaxonomyName": "Endodontics",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "1223P0106X",
"TaxonomyName": "Oral and Maxillofacial Pathology Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}