{
"Npi": {
"NPI": "1437312568",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WESTON FAMILY DENTAL SC",
"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": "3109 SHOREY AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54476-5648",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-241-6800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8055 MEADOW ROCK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54476-5241",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-241-6800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/09/2008",
"LastUpdateDate": "07/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRETL",
"AuthorizedOfficialFirstName": "HERBERT",
"AuthorizedOfficialMiddleName": "NICHOLAS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "715-432-0583",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "5378-015",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}