{
"Npi": {
"NPI": "1497276729",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAMILY & RESTORATIVE DENTISTRY",
"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": "7137 236TH AVE STE 108",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALEM",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53168-8975",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-843-4643",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7137 236TH AVE STE 108",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALEM",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53168-8975",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-843-4643",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2017",
"LastUpdateDate": "03/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FULMER",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "262-945-2084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "3667",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}