{
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"NPI": "1699082818",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RANDALL W HALLIDAY DDS, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "245 TERRACINA BLVD",
"SecondLineMailingAddress": "SUITE 211A",
"MailingAddressCityName": "REDLANDS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92373-4852",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-793-2629",
"MailingAddressFaxNumber": "909-798-2851",
"FirstLinePracticeLocationAddress": "245 TERRACINA BLVD",
"SecondLinePracticeLocationAddress": "SUITE 211A",
"PracticeLocationAddressCityName": "REDLANDS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92373-4852",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-793-2629",
"PracticeLocationAddressFaxNumber": "909-798-2851",
"EnumerationDate": "09/09/2010",
"LastUpdateDate": "09/09/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HALLIDAY",
"AuthorizedOfficialFirstName": "RANDALL",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "909-793-2629",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "22609",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}