{
"Npi": {
"NPI": "1639586258",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SULLIVAN",
"FirstName": "MICHAEL",
"MiddleName": "R",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3101 TREASURE HILLS BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HARLINGEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78550-8668",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-210-2810",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2106 TREASURE HILLS BLVD",
"SecondLinePracticeLocationAddress": "VA TEXAS VALLEY COASTAL BEND HEALTH CARE",
"PracticeLocationAddressCityName": "HARLINGEN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78550-8736",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-210-2810",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2014",
"LastUpdateDate": "02/08/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "30117",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}