{
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"OrgName": "CARPENTER DENTAL CHARLES M. CARPENTER CHARLES M. CARPENTER JR. P.C.",
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"FirstLineMailingAddress": "1086 WYOMING AVE",
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"MailingAddressCityName": "FORTY FORT",
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"MailingAddressPostalCode": "18704-4014",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-331-0909",
"MailingAddressFaxNumber": "570-714-5184",
"FirstLinePracticeLocationAddress": "1086 WYOMING AVE",
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"EnumerationDate": "08/21/2015",
"LastUpdateDate": "08/21/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARPENTER",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "MARK",
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"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "570-331-0909",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}