{
"Npi": {
"NPI": "1376738062",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COURTNEY L. STAADECKER, DDS, MS AND SCOTT T. OZAKI, DDS, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2452 FENTON ST",
"SecondLineMailingAddress": "SUITE 302",
"MailingAddressCityName": "CHULA VISTA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91914-3516",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-482-3205",
"MailingAddressFaxNumber": "619-482-3206",
"FirstLinePracticeLocationAddress": "2452 FENTON ST",
"SecondLinePracticeLocationAddress": "SUITE 302",
"PracticeLocationAddressCityName": "CHULA VISTA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91914-3516",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-482-3205",
"PracticeLocationAddressFaxNumber": "619-482-3206",
"EnumerationDate": "09/06/2007",
"LastUpdateDate": "09/06/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OZAKI",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "TADASHI",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "619-482-3205",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "41977",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}