{
"Npi": {
"NPI": "1568857472",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ATLANTIC DENTAL CARE, PLC",
"ParentOrgTIN": null,
"OrgName": "CENTER FOR RESTORATIVE, COSMETIC, AND IMPLANT DENTISTRY",
"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": "711 GREENBRIER PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHESAPEAKE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23320-3689",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-547-2770",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "711 GREENBRIER PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHESAPEAKE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23320-3689",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-547-2770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/30/2015",
"LastUpdateDate": "03/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONTGOMERY",
"AuthorizedOfficialFirstName": "KARYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "757-547-2770",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "0401412179",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}