{
"Npi": {
"NPI": "1275789315",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JEWELL DENTAL OF EASTPOINTE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "39500 W 14 MILE RD",
"SecondLineMailingAddress": "SUITE 307",
"MailingAddressCityName": "COMMERCE TOWNSHIP",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48390-3908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-535-7770",
"MailingAddressFaxNumber": "313-535-0280",
"FirstLinePracticeLocationAddress": "20770 KELLY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EASTPOINTE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48021-3114",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-778-6666",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/08/2008",
"LastUpdateDate": "08/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEWELL",
"AuthorizedOfficialFirstName": "REGINALD",
"AuthorizedOfficialMiddleName": "BERNARD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "586-778-6666",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "17336",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}