{
"Npi": {
"NPI": "1295218303",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED ORAL SURGERY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19318 IMPALA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEVILLE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55044-1600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "507-327-9574",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19925 IDEALIC AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKEVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55044-2003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "507-327-9574",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/13/2018",
"LastUpdateDate": "09/13/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCABE",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ORAL & MAXILLOFACIAL SURGEON",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD, MD",
"AuthorizedOfficialTelephoneNumber": "507-327-9574",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}