{
"Npi": {
"NPI": "1700290491",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRAWFORD DENTAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1115 S MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT SCOTT",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66701-2651",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "620-223-4448",
"MailingAddressFaxNumber": "620-223-9957",
"FirstLinePracticeLocationAddress": "1115 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT SCOTT",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "66701-2651",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "620-223-4448",
"PracticeLocationAddressFaxNumber": "620-223-9957",
"EnumerationDate": "06/20/2014",
"LastUpdateDate": "06/20/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRAWFORD",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "P.",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D",
"AuthorizedOfficialTelephoneNumber": "620-223-4448",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "60757",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}