{
"Npi": {
"NPI": "1871896753",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARK W. STAGIS DDS, NATHAN E. VICK DDS DENTAL GROUP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6215 N FRESNO ST",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "FRESNO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93710-5267",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-439-1245",
"MailingAddressFaxNumber": "559-439-0312",
"FirstLinePracticeLocationAddress": "6215 N FRESNO ST",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "FRESNO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93710-5267",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-439-1245",
"PracticeLocationAddressFaxNumber": "559-439-0312",
"EnumerationDate": "12/14/2010",
"LastUpdateDate": "12/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STAGIS",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "559-439-1245",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "59735",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "54793",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "28987",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}