{
"Npi": {
"NPI": "1902024425",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILE HIGH DENTAL CENTERS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8456 N HEATHER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CASTLE ROCK",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80108-9119",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-799-1715",
"MailingAddressFaxNumber": "303-799-1717",
"FirstLinePracticeLocationAddress": "1727 GILPIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DENVER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80218-1205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-388-1661",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/22/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOONE",
"AuthorizedOfficialFirstName": "MALCOLM",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "303-799-1715",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "104302",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}