{
"Npi": {
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "Y",
"ParentOrgLBN": "CLINT FULKS, INC.",
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"OrgName": "CLINT FULKS, INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "3316 HIGHWAY 5 N",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "BRYANT",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72019-9031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-847-6453",
"MailingAddressFaxNumber": "501-847-6460",
"FirstLinePracticeLocationAddress": "1200 FERGUSON DR",
"SecondLinePracticeLocationAddress": "SUITE 4",
"PracticeLocationAddressCityName": "BENTON",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72015-3503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-778-9222",
"PracticeLocationAddressFaxNumber": "501-778-9223",
"EnumerationDate": "12/11/2008",
"LastUpdateDate": "06/01/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FULKS",
"AuthorizedOfficialFirstName": "CLINT",
"AuthorizedOfficialMiddleName": "ALLEN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "501-350-4564",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "3521",
"LicenseNumberStateCode": "AR",
"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."
}
}
}
}