{
"Npi": {
"NPI": "1669691200",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KNOLL",
"FirstName": "MICHAEL",
"MiddleName": "R",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS, MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2242 SANTA CLARA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALAMEDA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94501-4417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-523-1862",
"MailingAddressFaxNumber": "510-521-1595",
"FirstLinePracticeLocationAddress": "2242 SANTA CLARA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALAMEDA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94501-4417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-523-1862",
"PracticeLocationAddressFaxNumber": "510-521-1595",
"EnumerationDate": "04/24/2007",
"LastUpdateDate": "02/11/2015",
"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": "204E00000X",
"TaxonomyName": "Oral & Maxillofacial Surgery (D.M.D.)",
"LicenseNumber": "30138",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "DN17902",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "5224",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "48487",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "204E00000X",
"TaxonomyName": "Oral & Maxillofacial Surgery (D.M.D.)",
"LicenseNumber": "A128233",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}