{
"Npi": {
"NPI": "1407166317",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHERN ORTHODONTICS",
"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": "13961 60TH ST N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STILLWATER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55082-1053",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-351-7777",
"MailingAddressFaxNumber": "651-439-2211",
"FirstLinePracticeLocationAddress": "1109 MOORE LAKE DR E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRIDLEY",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55432-5171",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-351-7777",
"PracticeLocationAddressFaxNumber": "651-439-2211",
"EnumerationDate": "10/13/2010",
"LastUpdateDate": "10/13/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOLFF",
"AuthorizedOfficialFirstName": "DOUGLAS",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "651-351-7777",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "11236",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}