{
"Npi": {
"NPI": "1225457328",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GARY D. KRUEGER, DDS, APC",
"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": "320 SANTA FE DRIVE",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "ENCINITAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92024-5140",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-479-0961",
"MailingAddressFaxNumber": "760-479-0963",
"FirstLinePracticeLocationAddress": "320 SANTA FE DR",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "ENCINITAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92024-5138",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-479-0961",
"PracticeLocationAddressFaxNumber": "760-479-0963",
"EnumerationDate": "04/16/2014",
"LastUpdateDate": "04/16/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KRUEGER",
"AuthorizedOfficialFirstName": "GARY",
"AuthorizedOfficialMiddleName": "DOUGLAS",
"AuthorizedOfficialTitle": "MAXILLOFACIAL PROSTHODONTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "760-479-0961",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0700X",
"TaxonomyName": "Prosthodontics",
"LicenseNumber": "42347",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}