{
"Npi": {
"NPI": "1710346218",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIVATE PRACTICE PEDIATRIC DENTISTRY",
"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": "CALLE 7 # 39-290",
"SecondLineMailingAddress": "OFICINA 901",
"MailingAddressCityName": "MEDELLIN",
"MailingAddressStateName": "ANTIOQUIA",
"MailingAddressPostalCode": "9999999",
"MailingAddressCountryCode": "CO",
"MailingAddressTelephoneNumber": "574-332-0454",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CALLE 7 # 39-290",
"SecondLinePracticeLocationAddress": "OFICINA 901",
"PracticeLocationAddressCityName": "MEDELLIN",
"PracticeLocationAddressStateName": "ANTIOQUIA",
"PracticeLocationAddressPostalCode": "9999999",
"PracticeLocationAddressCountryCode": "CO",
"PracticeLocationAddressTelephoneNumber": "574-332-0454",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/12/2016",
"LastUpdateDate": "02/12/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARDENAS",
"AuthorizedOfficialFirstName": "ANTONIO",
"AuthorizedOfficialMiddleName": "DARIO",
"AuthorizedOfficialTitle": "PEDIATRIC DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS, MSC",
"AuthorizedOfficialTelephoneNumber": "574-332-0454",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "2709",
"LicenseNumberStateCode": "ZZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}