{
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"IsOrgSubpart": "N",
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"OrgName": "BRADY CHRISTENSON FAMILY DENTISTRY",
"LastName": null,
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"FirstLineMailingAddress": "4701 COLUMBUS ST",
"SecondLineMailingAddress": "SUITE 105",
"MailingAddressCityName": "VIRGINIA BEACH",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23462-6725",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-473-5706",
"MailingAddressFaxNumber": "757-476-5792",
"FirstLinePracticeLocationAddress": "4701 COLUMBUS ST",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "VIRGINIA BEACH",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-473-5706",
"PracticeLocationAddressFaxNumber": "757-476-5792",
"EnumerationDate": "04/24/2007",
"LastUpdateDate": "02/19/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRADY",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "757-473-5706",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "6065",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}