{
"Npi": {
"NPI": "1568538098",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ORAL AND MAXILLOFACIAL SURGERY OF ANDERSON,LLC",
"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": "1514 NORTH FANT STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANDERSON",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29621-4708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "864-226-8559",
"MailingAddressFaxNumber": "864-226-8853",
"FirstLinePracticeLocationAddress": "1514 NORTH FANT STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANDERSON",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29621-4708",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-226-8559",
"PracticeLocationAddressFaxNumber": "864-226-8853",
"EnumerationDate": "11/27/2006",
"LastUpdateDate": "02/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUNLAP",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "ORAL SURGEON",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "864-226-8559",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "3257",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}