{
"Npi": {
"NPI": "1932604089",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOOD SHEPHERD DENTAL CARE PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 HAVERFORD RD STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAVERFORD",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19041-1139",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-642-3009",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "600 HAVERFORD RD STE 202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAVERFORD",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19041-1139",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-642-3009",
"PracticeLocationAddressFaxNumber": "610-642-2328",
"EnumerationDate": "03/29/2018",
"LastUpdateDate": "07/29/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOULIMAN",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BDS, DMD",
"AuthorizedOfficialTelephoneNumber": "848-333-5550",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DS039840",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}