{
"Npi": {
"NPI": "1831610120",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LADD DENTAL GROUP OF MCCORDSVILLE, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2333 W LINCOLN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KOKOMO",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46902-8012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-455-0085",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6653 W BROADWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MCCORDSVILLE",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46055-9558",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-455-0085",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/28/2017",
"LastUpdateDate": "08/02/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LADD",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "765-455-0085",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}