{
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"IsOrgSubpart": "N",
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"OrgName": "PACIFIC NORTHWEST ORAL AND MAXILLOFACIAL SURGERY",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2345 SW 320TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FEDERAL WAY",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98023-2568",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-838-2123",
"MailingAddressFaxNumber": "253-874-3624",
"FirstLinePracticeLocationAddress": "2345 SW 320TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FEDERAL WAY",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-838-2123",
"PracticeLocationAddressFaxNumber": "253-874-3624",
"EnumerationDate": "07/01/2014",
"LastUpdateDate": "07/01/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": "KENNETH",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "425-277-1844",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery Clinic/Center",
"LicenseNumber": "DE00006475",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}