{
"Npi": {
"NPI": "1710435151",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JACK D SPENCER,DMD",
"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": "180 FORT COUCH RD",
"SecondLineMailingAddress": "ST 415",
"MailingAddressCityName": "PITTSBURGH",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15241-1041",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-835-2288",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "180 FORT COUCH RD",
"SecondLinePracticeLocationAddress": "ST 415",
"PracticeLocationAddressCityName": "PITTSBURGH",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15241-1041",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-835-2288",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2016",
"LastUpdateDate": "09/14/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPENCER",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "412-835-2288",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DS 021308-L",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}