{
"Npi": {
"NPI": "1932373636",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "J. MICHAEL PANCZYSZYN, D.D.S., PA",
"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": "938 BRIDGEWATER DR",
"SecondLineMailingAddress": "UNIT 3B",
"MailingAddressCityName": "PORT ORANGE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32129-6108",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-756-3728",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "938 BRIDGEWATER DR",
"SecondLinePracticeLocationAddress": "UNIT 3B",
"PracticeLocationAddressCityName": "PORT ORANGE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32129-6108",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-756-3728",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/15/2008",
"LastUpdateDate": "04/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PANCZYSZYN",
"AuthorizedOfficialFirstName": "J.",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "386-756-3728",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DN0009950",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}