{
"Npi": {
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"IsOrgSubpart": "N",
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"OrgName": "NORTHSTAR ORTHODONTICS, INC.",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "218 INDUSTRIAL PARK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PARK RAPIDS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56470-3508",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-732-9503",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "218 INDUSTRIAL PARK RD",
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"PracticeLocationAddressCityName": "PARK RAPIDS",
"PracticeLocationAddressStateName": "MN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-732-9503",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/10/2016",
"LastUpdateDate": "05/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLY",
"AuthorizedOfficialFirstName": "CYNTHIA",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "218-732-9503",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Laboratory",
"LicenseNumber": "DL109",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}