{
"Npi": {
"NPI": "1437545829",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LINCOLN PEDIATRIC DENTISTRY",
"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": "PO BOX 699",
"SecondLineMailingAddress": "25 SO. MTN. DR., A-3",
"MailingAddressCityName": "LINCOLN",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03251",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-745-7266",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "25 SOUTH MOUNTAIN RD.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LINCOLN",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03251",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-745-7266",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/13/2015",
"LastUpdateDate": "04/13/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAPOZZI",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "F.",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "603-745-7266",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "3561",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "3893",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "3970",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "3005",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "3985",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}