{
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"OrgName": "TOTAL FREEDOM DENTAL IMPLANT CENTER",
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"NamePrefix": null,
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"FirstLineMailingAddress": "9002 E DESERT COVE AVE",
"SecondLineMailingAddress": "#101",
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85260-6710",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-860-9002",
"MailingAddressFaxNumber": "480-451-9378",
"FirstLinePracticeLocationAddress": "9002 E DESERT COVE AVE",
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"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressTelephoneNumber": "480-860-9002",
"PracticeLocationAddressFaxNumber": "480-451-9378",
"EnumerationDate": "01/12/2011",
"LastUpdateDate": "01/12/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMS",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "PARTNER",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "480-860-9002",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "3573",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}