{
"Npi": {
"NPI": "1508374497",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAKOTA DENTAL CENTER, P.L.L.C.",
"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": "PO BOX E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOWMAN",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58623-0119",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "20 1ST AVE SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOWMAN",
"PracticeLocationAddressStateName": "ND",
"PracticeLocationAddressPostalCode": "58623-4213",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-523-5651",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/14/2018",
"LastUpdateDate": "01/14/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACQUOT",
"AuthorizedOfficialFirstName": "CAITLIN",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PRESIDENT/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "701-523-5651",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "2291",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}