{
"Npi": {
"NPI": "1245871326",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BISHOP",
"FirstName": "MASON",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "322 TURNPIKE RD STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUMMERSVILLE",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26651-1378",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-619-6305",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "402 RED OAK ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUMMERSVILLE",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26651-1000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-872-5600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/30/2019",
"LastUpdateDate": "07/13/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "4409",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}