{
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"OrgName": "KRIVARCHKA FAMILY DENTISTRY P.C.",
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"FirstLineMailingAddress": "7608 W GRINNELL CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIOUX FALLS",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57106-7669",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-951-1084",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1511 W HOLLY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRANDON",
"PracticeLocationAddressStateName": "SD",
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"EnumerationDate": "07/25/2012",
"LastUpdateDate": "07/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KRIVARCHKA",
"AuthorizedOfficialFirstName": "MATT",
"AuthorizedOfficialMiddleName": "VICTOR",
"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "605-951-1084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "D0911",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}