{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NATHAN D. WILLIAMSON, D.M.D., LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "606 S TRUMAN BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FESTUS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63028-2235",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-937-3870",
"MailingAddressFaxNumber": "636-937-9241",
"FirstLinePracticeLocationAddress": "606 S TRUMAN BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FESTUS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63028-2235",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-937-3870",
"PracticeLocationAddressFaxNumber": "636-937-9241",
"EnumerationDate": "09/28/2020",
"LastUpdateDate": "09/28/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMSON",
"AuthorizedOfficialFirstName": "NATHAN",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "636-937-3870",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}