{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ANDREW M JOHNSON DDS, PA",
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"NameSuffix": null,
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"FirstLineMailingAddress": "2700 COLTSGATE RD",
"SecondLineMailingAddress": "SUITE 204",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28211-3799",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-749-5700",
"MailingAddressFaxNumber": "704-749-5701",
"FirstLinePracticeLocationAddress": "2700 COLTSGATE RD",
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"PracticeLocationAddressCityName": "CHARLOTTE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-749-5700",
"PracticeLocationAddressFaxNumber": "704-749-5701",
"EnumerationDate": "07/03/2009",
"LastUpdateDate": "07/03/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "ANDREW",
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"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "704-749-5700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "8388",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}