{
"Npi": {
"NPI": "1699073841",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLIAM A. GILLIARD DMD LLC",
"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": "255 N. HWY 52",
"SecondLineMailingAddress": "SUITE 9",
"MailingAddressCityName": "MONCKS CORNER",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29461",
"MailingAddressCountryCode": "UM",
"MailingAddressTelephoneNumber": "843-761-1600",
"MailingAddressFaxNumber": "843-761-3669",
"FirstLinePracticeLocationAddress": "255 N HIGHWAY 52",
"SecondLinePracticeLocationAddress": "SUITE 9",
"PracticeLocationAddressCityName": "MONCKS CORNER",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29461-3927",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-761-1600",
"PracticeLocationAddressFaxNumber": "843-761-3669",
"EnumerationDate": "03/10/2011",
"LastUpdateDate": "03/10/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GILLIARD",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "ANTONIO",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "843-761-1600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "3735",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}