{
"Npi": {
"NPI": "1477667913",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHILDREN'S DENTAL CLINIC, PC",
"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": "2840 S 70TH ST",
"SecondLineMailingAddress": "SUITE 7-352",
"MailingAddressCityName": "LINCOLN",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68506-3662",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "308-384-0332",
"MailingAddressFaxNumber": "402-797-2064",
"FirstLinePracticeLocationAddress": "3721 W 13TH",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "GRAND ISLAND",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68803",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "308-384-0332",
"PracticeLocationAddressFaxNumber": "402-797-2064",
"EnumerationDate": "08/19/2006",
"LastUpdateDate": "05/09/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEYER",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "PHILIP",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "308-384-0332",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "4908",
"LicenseNumberStateCode": "NE",
"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."
}
}
}
}