{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DR. KENNETH PALM",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "106 HIGH POINT CTR",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "COLCHESTER",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05446-5861",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-655-5308",
"MailingAddressFaxNumber": "802-655-5715",
"FirstLinePracticeLocationAddress": "106 HIGH POINT CTR",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "COLCHESTER",
"PracticeLocationAddressStateName": "VT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-655-5308",
"PracticeLocationAddressFaxNumber": "802-655-5715",
"EnumerationDate": "05/09/2007",
"LastUpdateDate": "07/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PALM",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "802-655-5308",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "01237",
"LicenseNumberStateCode": "VT",
"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."
}
}
}
}