{
"Npi": {
"NPI": "1922424738",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CORNELIUS TENDERCARE DENTAL PC",
"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": "1890 BASELINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORNELIUS",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97113-8208",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-357-0004",
"MailingAddressFaxNumber": "503-359-8856",
"FirstLinePracticeLocationAddress": "1890 BASELINE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORNELIUS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97113-8208",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-357-0004",
"PracticeLocationAddressFaxNumber": "503-359-8856",
"EnumerationDate": "03/17/2014",
"LastUpdateDate": "03/17/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAROSTICA",
"AuthorizedOfficialFirstName": "JUSTIN",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "503-858-0741",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "9419",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}