{
"Npi": {
"NPI": "1750930525",
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "KYLE R DANIELSON, DDS, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4165 SHORELINE DR STE 30",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRING PARK",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55384-9653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4165 SHORELINE DR STE 30",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRING PARK",
"PracticeLocationAddressStateName": "MN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-471-0047",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/05/2019",
"LastUpdateDate": "09/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANIELSON",
"AuthorizedOfficialFirstName": "KYLE",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "320-282-5953",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}