{
"Npi": {
"NPI": "1508316910",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DRS. OTTOSEN AND NYGARD, PLLC",
"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": "1001 W BROADWAY AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOSES LAKE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98837-2604",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "509-766-8968",
"MailingAddressFaxNumber": "509-766-8967",
"FirstLinePracticeLocationAddress": "1001 W BROADWAY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOSES LAKE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98837-2604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "509-766-8968",
"PracticeLocationAddressFaxNumber": "509-766-8967",
"EnumerationDate": "10/10/2016",
"LastUpdateDate": "10/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OTTOSEN",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS, MSD",
"AuthorizedOfficialTelephoneNumber": "509-664-6669",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "604-034-843",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}