{
"Npi": {
"NPI": "1356553770",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROBERT L. DONALD, JR., D.D.S. PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 8336",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAUREL",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39441-8336",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-649-2222",
"MailingAddressFaxNumber": "601-649-0255",
"FirstLinePracticeLocationAddress": "3228 OLD BAY SPRINGS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAUREL",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39440-1453",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-649-2222",
"PracticeLocationAddressFaxNumber": "601-649-0255",
"EnumerationDate": "05/06/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DONALD, JR.",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "601-643-2222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "79556",
"LicenseNumberStateCode": "MS",
"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."
}
}
}
}