{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "2425 MILITARY ST",
"SecondLineMailingAddress": "BLDG 4",
"MailingAddressCityName": "PORT HURON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48060-6692",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-982-5334",
"MailingAddressFaxNumber": "810-982-1306",
"FirstLinePracticeLocationAddress": "2425 MILITARY ST",
"SecondLinePracticeLocationAddress": "BLDG. 4",
"PracticeLocationAddressCityName": "PORT HURON",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-982-5334",
"PracticeLocationAddressFaxNumber": "810-982-1306",
"EnumerationDate": "12/30/2016",
"LastUpdateDate": "12/30/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOYD",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "810-982-5334",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "15589",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}