{
"Npi": {
"NPI": "1932323433",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARC L GROSSMAN DDS JAMES B SMITH DDS APC",
"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": "228 GREEN VALLEY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREEDOM",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95019-3136",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "831-722-9202",
"MailingAddressFaxNumber": "831-722-4301",
"FirstLinePracticeLocationAddress": "228 GREEN VALLEY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREEDOM",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95019-3136",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "831-722-9202",
"PracticeLocationAddressFaxNumber": "831-722-4301",
"EnumerationDate": "04/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GROSSMAN",
"AuthorizedOfficialFirstName": "MARC",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "831-722-9202",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "26311",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}