{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHERMAN AND HALLIE DDS PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 36",
"SecondLineMailingAddress": "520 5TH ST NW",
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55744",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-326-2901",
"MailingAddressFaxNumber": "218-327-2080",
"FirstLinePracticeLocationAddress": "520 5TH ST NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND RAPIDS",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55744",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-326-2901",
"PracticeLocationAddressFaxNumber": "218-327-2080",
"EnumerationDate": "11/21/2007",
"LastUpdateDate": "11/21/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHERMAN",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "DENTIST OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DR",
"AuthorizedOfficialTelephoneNumber": "218-326-2901",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "D11926",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}