{
"Npi": {
"NPI": "1497187769",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PIEDMONT PEDIATRIC DENTISTRY PLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "240 HYDRAULIC RIDGE RD",
"SecondLineMailingAddress": "SUITE 203",
"MailingAddressCityName": "CHARLOTTESVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22901-8130",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-973-4344",
"MailingAddressFaxNumber": "434-973-4675",
"FirstLinePracticeLocationAddress": "240 HYDRAULIC RIDGE RD",
"SecondLinePracticeLocationAddress": "SUITE 203",
"PracticeLocationAddressCityName": "CHARLOTTESVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22901-8130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-973-4344",
"PracticeLocationAddressFaxNumber": "434-973-4675",
"EnumerationDate": "08/08/2013",
"LastUpdateDate": "10/14/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PETERS",
"AuthorizedOfficialFirstName": "BARRETT",
"AuthorizedOfficialMiddleName": "W R",
"AuthorizedOfficialTitle": "MEMBER/MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS MSD",
"AuthorizedOfficialTelephoneNumber": "434-973-4344",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "0401413204",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}