{
"Npi": {
"NPI": "1275904641",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DESOTO DENTAL PLLC",
"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": "3200 PARKWOOD BLVD",
"SecondLineMailingAddress": "#310",
"MailingAddressCityName": "PLANO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75093-8750",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-750-0610",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "116 W PARKERVILLE RD",
"SecondLinePracticeLocationAddress": "STE # 112",
"PracticeLocationAddressCityName": "DESOTO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-750-0610",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/12/2015",
"LastUpdateDate": "02/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONDI",
"AuthorizedOfficialFirstName": "MAHESH",
"AuthorizedOfficialMiddleName": "BABU",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "972-750-0610",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "22213",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}