{
"Npi": {
"NPI": "1235383019",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COSMETIC AND RESTORATIVE GENERAL DENTISTRY",
"ParentOrgTIN": null,
"OrgName": "GENERAL FAMILY DENTISTRY",
"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": "108 W POINT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROANOKE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36274-1686",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-863-4514",
"MailingAddressFaxNumber": "334-863-4470",
"FirstLinePracticeLocationAddress": "108 W POINT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROANOKE",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36274-1686",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-863-4514",
"PracticeLocationAddressFaxNumber": "334-863-4470",
"EnumerationDate": "11/06/2008",
"LastUpdateDate": "04/28/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TYRER",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "706-882-0094",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "5533",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}