{
"Npi": {
"NPI": "1750861233",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VAIL FAMILY 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": "13190 E COLOSSAL CAVE RD STE 150",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VAIL",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85641-8822",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-762-3236",
"MailingAddressFaxNumber": "520-762-8058",
"FirstLinePracticeLocationAddress": "13190 E COLOSSAL CAVE RD STE 150",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VAIL",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85641-8822",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-762-3236",
"PracticeLocationAddressFaxNumber": "520-762-8058",
"EnumerationDate": "08/15/2018",
"LastUpdateDate": "08/15/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BALLEW",
"AuthorizedOfficialFirstName": "SEAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "520-762-3236",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D7579",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}