{
"Npi": {
"NPI": "1669688750",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VANESSA N. KELLER, D.M.D. AND TRISHA M. YOUNG, D.M.D., PC",
"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": "165 N MERAMEC AVE",
"SecondLineMailingAddress": "SUITE 420",
"MailingAddressCityName": "CLAYTON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63105-3772",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-725-4343",
"MailingAddressFaxNumber": "314-725-3950",
"FirstLinePracticeLocationAddress": "165 N MERAMEC AVE",
"SecondLinePracticeLocationAddress": "SUITE 420",
"PracticeLocationAddressCityName": "CLAYTON",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63105-3772",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-725-4343",
"PracticeLocationAddressFaxNumber": "314-725-3950",
"EnumerationDate": "05/15/2007",
"LastUpdateDate": "08/04/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLER",
"AuthorizedOfficialFirstName": "VANESSA",
"AuthorizedOfficialMiddleName": "NICOLE",
"AuthorizedOfficialTitle": "PRESIDENT OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "314-725-4343",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "11994",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}