{
"Npi": {
"NPI": "1245484310",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "AMERICAN DENTAL ASSOCIATES PLLC",
"ParentOrgTIN": null,
"OrgName": "AMERICAN DENTAL ASSOCIATES",
"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": "179 MAIN ST",
"SecondLineMailingAddress": "SUITE 212",
"MailingAddressCityName": "WATERVILLE",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04901-6672",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-872-6815",
"MailingAddressFaxNumber": "207-872-6815",
"FirstLinePracticeLocationAddress": "179 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 212",
"PracticeLocationAddressCityName": "WATERVILLE",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04901-6672",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-872-6815",
"PracticeLocationAddressFaxNumber": "207-872-6815",
"EnumerationDate": "11/16/2008",
"LastUpdateDate": "11/16/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AKINSANYA",
"AuthorizedOfficialFirstName": "OLUGBENGA",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "207-872-6815",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "4077",
"LicenseNumberStateCode": "ME",
"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."
}
}
}
}