{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"FirstLineMailingAddress": "13925 W MEEKER BLVD",
"SecondLineMailingAddress": "SUITE 1A",
"MailingAddressCityName": "SUN CITY WEST",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85375-4430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-584-0733",
"MailingAddressFaxNumber": "623-584-1799",
"FirstLinePracticeLocationAddress": "13925 W MEEKER BLVD",
"SecondLinePracticeLocationAddress": "SUITE 1A",
"PracticeLocationAddressCityName": "SUN CITY WEST",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85375-4430",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-584-0733",
"PracticeLocationAddressFaxNumber": "623-584-1799",
"EnumerationDate": "08/04/2016",
"LastUpdateDate": "08/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPERRY",
"AuthorizedOfficialFirstName": "BRETT",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "623-584-0733",
"Taxonomies": {
"Taxonomy": [
{
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"TaxonomyName": "Dentist",
"LicenseNumber": "D02611",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}