{
"Npi": {
"NPI": "1699204172",
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"EIN": null,
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"IsOrgSubpart": "Y",
"ParentOrgLBN": "WEST LAKES DENTISTRY, PA",
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"OrgName": "WLD2, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1635 SUNNYBROOK CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MINNETRISTA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55364-1276",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "16123875009",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "132 PIONEER TRL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHASKA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55318-1167",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-361-3740",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/08/2017",
"LastUpdateDate": "06/08/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MINER",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "612-387-5009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D11974",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}