{
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"NPI": "1407027402",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CARLA M. KEENE, D.D.S.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 287",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ABINGDON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24212-0287",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-676-0070",
"MailingAddressFaxNumber": "276-676-0880",
"FirstLinePracticeLocationAddress": "15189 PORTERFIELD HIGHWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ABINGDON",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24211",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-676-0070",
"PracticeLocationAddressFaxNumber": "276-676-0880",
"EnumerationDate": "03/18/2008",
"LastUpdateDate": "10/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEENE",
"AuthorizedOfficialFirstName": "CARLA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "DENTAL PRACTITIONER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "276-676-0070",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0401007589",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}