{
"Npi": {
"NPI": "1659762607",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TN DENTSL SPECIALIST",
"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": "405 WILD ELM ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRANKLIN",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37064-8650",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-310-0022",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1441 NEW HIGHWAY 96 W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRANKLIN",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37064-4830",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-310-0022",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/12/2015",
"LastUpdateDate": "02/12/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NORTHCUTT",
"AuthorizedOfficialFirstName": "DANNY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-310-0022",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "7885",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}