{
"Npi": {
"NPI": "1881045698",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "STONE RIDGE DENTAL",
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"OrgName": "STONE RIDGE SUGAR CITY DBA STONE RIDGE DENTAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3 E CENTER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUGAR CITY",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83448-1247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-656-2000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3 E CENTER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUGAR CITY",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-656-2000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2016",
"LastUpdateDate": "06/23/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARPENTER",
"AuthorizedOfficialFirstName": "CURTIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "208-656-2000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D-4169",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}