{
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"OrgName": "MIDNITE DENTAL, PLLC",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3126",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MCALLEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78502-3126",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-225-6675",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "801 E NOLANA AVE",
"SecondLinePracticeLocationAddress": "SUITE # 14",
"PracticeLocationAddressCityName": "MCALLEN",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "07/04/2014",
"LastUpdateDate": "04/26/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RADTKE",
"AuthorizedOfficialFirstName": "KLAUS",
"AuthorizedOfficialMiddleName": "JOHANN",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "26256",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}