{
"Npi": {
"NPI": "1669848891",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAGNOLIA SMILES",
"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": "1220 N WASHINGTON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DURANT",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74701-2120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-745-5400",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1220 N WASHINGTON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DURANT",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74701-2120",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-745-5400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/11/2015",
"LastUpdateDate": "08/11/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HILL",
"AuthorizedOfficialFirstName": "BENJAMIN",
"AuthorizedOfficialMiddleName": "TYLER",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "580-745-5400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "6270",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}