{
"Npi": {
"NPI": "1770705386",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHILLIP W. OLRICH D.D.S.,INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "407 41ST STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKLAND",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94609-2510",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-658-5483",
"MailingAddressFaxNumber": "510-658-5484",
"FirstLinePracticeLocationAddress": "407 41ST STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAKLAND",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94609-2510",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-658-5483",
"PracticeLocationAddressFaxNumber": "510-658-5484",
"EnumerationDate": "05/03/2007",
"LastUpdateDate": "08/21/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OLRICH",
"AuthorizedOfficialFirstName": "PHILLIP",
"AuthorizedOfficialMiddleName": "W.",
"AuthorizedOfficialTitle": "PRESIDENT-DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "510-658-5483",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "22834",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}