{
"Npi": {
"NPI": "1629306998",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SMILES FOREVER",
"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": "196 THOMAS JOHNSON DR",
"SecondLineMailingAddress": "SUITE #235",
"MailingAddressCityName": "FREDERICK",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21702",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-668-7700",
"MailingAddressFaxNumber": "301-668-7800",
"FirstLinePracticeLocationAddress": "196 THOMAS JOHNSON DR",
"SecondLinePracticeLocationAddress": "SUITE #235",
"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21702",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-668-7700",
"PracticeLocationAddressFaxNumber": "301-668-7800",
"EnumerationDate": "11/25/2009",
"LastUpdateDate": "11/25/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCLEOD",
"AuthorizedOfficialFirstName": "PAT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRACTICE OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "301-668-7700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "13234",
"LicenseNumberStateCode": "MD",
"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."
}
}
}
}