{
"Npi": {
"NPI": "1578991162",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHAEL P. WILSON, DDS, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "30 W STATE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BINGHAMTON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13901-2332",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-238-1280",
"MailingAddressFaxNumber": "607-238-1286",
"FirstLinePracticeLocationAddress": "7677 CENTER AVE",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "HUNTINGTON BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92647-3074",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-238-1280",
"PracticeLocationAddressFaxNumber": "607-238-1286",
"EnumerationDate": "10/17/2013",
"LastUpdateDate": "10/17/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILSON",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "OWNER-PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "607-238-1280",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "62234",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}