{
"Npi": {
"NPI": "1356667323",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENNIS G PETTIT DDS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1762 COMMERCE CENTER BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRBORN",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45324-6358",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-878-8694",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1762 COMMERCE CENTER BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAIRBORN",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45324-6358",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-878-8694",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/15/2010",
"LastUpdateDate": "04/23/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PETTIT",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "937-878-8694",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery Clinic/Center",
"LicenseNumber": "30-01-8161",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}