{
"Npi": {
"NPI": "1649590829",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR. DENNIS L. NIERENGARTEN, D.D.S., P.A.",
"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": "1511 NORTHWAY DR STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT CLOUD",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56303-1262",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "320-255-1020",
"MailingAddressFaxNumber": "320-255-1020",
"FirstLinePracticeLocationAddress": "1511 NORTHWAY DR STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT CLOUD",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56303-1262",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-255-1020",
"PracticeLocationAddressFaxNumber": "320-255-1020",
"EnumerationDate": "06/10/2010",
"LastUpdateDate": "06/10/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NIERENGARTEN",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S., P.A.",
"AuthorizedOfficialTelephoneNumber": "320-255-1020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "D9004",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}