{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CASEY J OWEN DDS FAMILY DENTISTRY PLLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "14 MAIN ST E",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "GORDONSVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38563-2036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-683-6161",
"MailingAddressFaxNumber": "615-683-6164",
"FirstLinePracticeLocationAddress": "14 MAIN ST E",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "GORDONSVILLE",
"PracticeLocationAddressStateName": "TN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-683-6161",
"PracticeLocationAddressFaxNumber": "615-683-6164",
"EnumerationDate": "11/18/2014",
"LastUpdateDate": "11/18/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OWEN",
"AuthorizedOfficialFirstName": "CASEY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "615-683-6161",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "9320",
"LicenseNumberStateCode": "TN",
"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."
}
}
}
}