{
"Npi": {
"NPI": "1558752352",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FREDERICK J WORRELL DDS 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": "16005 NE 198TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODINVILLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98072-7016",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3625 148TH ST SW",
"SecondLinePracticeLocationAddress": "SUITE# B101",
"PracticeLocationAddressCityName": "LYNNWOOD",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98087-5577",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-773-4909",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/15/2015",
"LastUpdateDate": "02/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WORRELL",
"AuthorizedOfficialFirstName": "FREDERICK",
"AuthorizedOfficialMiddleName": "JULIAN",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "206-294-9001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DE60238959",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}