{
"Npi": {
"NPI": "1669977427",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "A COUNTRY DENTIST, PLLC",
"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": "107 W 9TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT MORGAN",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80701-2011",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-867-2502",
"MailingAddressFaxNumber": "970-867-3795",
"FirstLinePracticeLocationAddress": "107 W 9TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT MORGAN",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80701-2011",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-867-2502",
"PracticeLocationAddressFaxNumber": "970-867-3795",
"EnumerationDate": "03/26/2018",
"LastUpdateDate": "03/26/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCARPELLA",
"AuthorizedOfficialFirstName": "PASCO",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "303-335-8160",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "106313",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}