{
"Npi": {
"NPI": "1366600850",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHORT CLINE",
"FirstName": "MISTY",
"MiddleName": "M",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CLINE",
"OtherFirstName": "MISTY",
"OtherMiddleName": "M",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "517 TAZEWELL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLUEFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24605-1724",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-322-7568",
"MailingAddressFaxNumber": "276-322-7269",
"FirstLinePracticeLocationAddress": "517 TAZEWELL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLUEFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24605-1724",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-322-7568",
"PracticeLocationAddressFaxNumber": "276-322-7269",
"EnumerationDate": "05/30/2008",
"LastUpdateDate": "01/21/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "3816",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "0401412415",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}