{
"Npi": {
"NPI": "1811690092",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHARLOTTE ETESSE DDS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "530 LOMAS SANTA FE DR STE K",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOLANA BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92075-1346",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-794-7768",
"MailingAddressFaxNumber": "858-794-7765",
"FirstLinePracticeLocationAddress": "530 LOMAS SANTA FE DR STE K",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOLANA BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92075-1346",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-794-7768",
"PracticeLocationAddressFaxNumber": "858-794-7765",
"EnumerationDate": "03/24/2023",
"LastUpdateDate": "03/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ETESSE",
"AuthorizedOfficialFirstName": "CHARLOTTE",
"AuthorizedOfficialMiddleName": "EUGENIE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "818-939-4801",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}