{
"Npi": {
"NPI": "1285117507",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BPM DENTAL PARTNERSHIP",
"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": "110 TOWN CENTER PKWY STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTEE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92071-5801",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-562-5437",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "110 TOWN CENTER PKWY STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTEE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92071-5801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-562-5437",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/12/2018",
"LastUpdateDate": "09/12/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUZZELL",
"AuthorizedOfficialFirstName": "JORDAN",
"AuthorizedOfficialMiddleName": "N.",
"AuthorizedOfficialTitle": "LEAD PEDIATRIC DENTIST/OWNER DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS, MPH",
"AuthorizedOfficialTelephoneNumber": "619-562-5437",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}