{
"Npi": {
"NPI": "1548776073",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WALKER SQUARE DENTAL,INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "838 WALKER RD STE 21-1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOVER",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19904-2751",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-736-1423",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "838 WALKER RD STE 21-1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DOVER",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19904-2751",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-736-1423",
"PracticeLocationAddressFaxNumber": "302-736-5538",
"EnumerationDate": "12/20/2017",
"LastUpdateDate": "12/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROGGE",
"AuthorizedOfficialFirstName": "BERND",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "302-736-1423",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "G1-0000987",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}