{
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"NPI": "1326431479",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRADEN H GISWOLD DDS PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "742 CAMANO AVE STE 101A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANGLEY",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98260-9570",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-221-6373",
"MailingAddressFaxNumber": "360-221-6375",
"FirstLinePracticeLocationAddress": "742 CAMANO AVE STE 101A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANGLEY",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98260-9570",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-221-6373",
"PracticeLocationAddressFaxNumber": "360-221-6375",
"EnumerationDate": "03/13/2015",
"LastUpdateDate": "03/13/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GISWOLD",
"AuthorizedOfficialFirstName": "BRADEN",
"AuthorizedOfficialMiddleName": "HIROSHI",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "360-221-6373",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
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"LicenseNumberStateCode": "WA",
"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."
}
}
}
}