{
"Npi": {
"NPI": "1881860914",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLADSTONE FAMILY DENTISTRY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1105 PORTLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLADSTONE",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97027-2170",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-657-3077",
"MailingAddressFaxNumber": "503-655-5729",
"FirstLinePracticeLocationAddress": "1105 PORTLAND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLADSTONE",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97027-2170",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-657-3077",
"PracticeLocationAddressFaxNumber": "503-655-5729",
"EnumerationDate": "05/08/2008",
"LastUpdateDate": "05/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KATO",
"AuthorizedOfficialFirstName": "JEREMY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "503-657-3077",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D8790",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D6082",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}