{
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"EIN": null,
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"IsOrgSubpart": "N",
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "135 E MARKET ST STE 116",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLAIRSVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15717-1369",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-459-5310",
"MailingAddressFaxNumber": "724-459-5848",
"FirstLinePracticeLocationAddress": "135 E MARKET ST STE 116",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLAIRSVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-459-5310",
"PracticeLocationAddressFaxNumber": "724-459-5848",
"EnumerationDate": "12/20/2018",
"LastUpdateDate": "12/20/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JORDAN",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "L",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "724-459-5310",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}