{
"Npi": {
"NPI": "1851891964",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "KLEEN DENTAL PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1076 ARCHES PARK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALLEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75013-5649",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "630 W INTERSTATE 30 STE 610",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARLAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75043-5799",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-226-7600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/15/2018",
"LastUpdateDate": "02/15/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KONEGOWDA",
"AuthorizedOfficialFirstName": "VIDYAVATHI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "248-495-3487",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}