{
"Npi": {
"NPI": "1679321343",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENTAL EXCELLENCE GROUP",
"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": "875 WESTMORELAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPOLEON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43545-1260",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-478-0988",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "875 WESTMORELAND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAPOLEON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43545-1260",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-478-0988",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/08/2024",
"LastUpdateDate": "05/08/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARPENTER",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "DEAN",
"AuthorizedOfficialTitle": "CEO/ CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "419-466-1259",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}