{
"Npi": {
"NPI": "1255569315",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NEELY",
"FirstName": "MARTHA",
"MiddleName": "LUCIA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.M.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "VASQUEZ",
"OtherFirstName": "MARTHA",
"OtherMiddleName": "LUCIA",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.D.S",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "60 SAGAMORE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REVERE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02151-2537",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-853-9992",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "119 MASSACHUSETTS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LUNENBURG",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01462-1274",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "978-345-7988",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/29/2009",
"LastUpdateDate": "03/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "10203",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "DN1856348",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}