{
"Npi": {
"NPI": "1649437112",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLIAM C. DALE, DMD, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4200 N CLOVERLEAF DR",
"SecondLineMailingAddress": "STE. Q",
"MailingAddressCityName": "SAINT PETERS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63376-6436",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-928-1167",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4200 N CLOVERLEAF DR",
"SecondLinePracticeLocationAddress": "STE. Q",
"PracticeLocationAddressCityName": "SAINT PETERS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63376-6436",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-928-1167",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/21/2008",
"LastUpdateDate": "05/21/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DALE",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "CHARLES",
"AuthorizedOfficialTitle": "SOLE MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "636-928-1167",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "014742",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}