{
"Npi": {
"NPI": "1376798405",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARSHALL A STORM DDS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "841 MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALPOLE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02081-2997",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-668-1766",
"MailingAddressFaxNumber": "508-668-0308",
"FirstLinePracticeLocationAddress": "841 MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WALPOLE",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02081-2997",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-668-1766",
"PracticeLocationAddressFaxNumber": "508-668-0308",
"EnumerationDate": "11/17/2008",
"LastUpdateDate": "11/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STORM",
"AuthorizedOfficialFirstName": "MARSHALL",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "508-668-1766",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "18896",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}