{
"Npi": {
"NPI": "1669771069",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ATWOOD FAMILY DENTISTRY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1759 W BROADWAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IDAHO FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83402-3045",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-313-0520",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1759 W BROADWAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IDAHO FALLS",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83402-3045",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-313-0520",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/24/2011",
"LastUpdateDate": "03/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ATWOOD",
"AuthorizedOfficialFirstName": "BRODIE",
"AuthorizedOfficialMiddleName": "STEVEN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D",
"AuthorizedOfficialTelephoneNumber": "208-313-0520",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D4289",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}