{
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"EIN": null,
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"OrgName": "GLENN S. PARRY, DMD, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1002",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREEN RIVER",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82935-1002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-875-7770",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "220 SHOSHONE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREEN RIVER",
"PracticeLocationAddressStateName": "WY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-875-7770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/25/2007",
"LastUpdateDate": "09/24/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARRY",
"AuthorizedOfficialFirstName": "GLENN",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "307-875-7770",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "670",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}