{
"Npi": {
"NPI": "1245320449",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARK L. MCCLENDON, PA",
"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": "1020 N MILLS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARCADIA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34266-8811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-494-6116",
"MailingAddressFaxNumber": "863-494-2660",
"FirstLinePracticeLocationAddress": "1020 N MILLS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARCADIA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34266-8811",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-494-6116",
"PracticeLocationAddressFaxNumber": "863-494-2660",
"EnumerationDate": "10/16/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCLENDON",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "LESTER",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "863-494-6116",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN0011846",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}