{
"Npi": {
"NPI": "1932767092",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GRUSZCYNSKI",
"FirstName": "KAYLA",
"MiddleName": "JO",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WEATHERWAX",
"OtherFirstName": "KAYLA",
"OtherMiddleName": "JO",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "907 S US HIGHWAY 27",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT JOHNS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48879-2435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-224-7559",
"MailingAddressFaxNumber": "989-224-2704",
"FirstLinePracticeLocationAddress": "7451 DR MARTIN LUTHER KING JR ST N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PETERSBURG",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33702-5203",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-522-2222",
"PracticeLocationAddressFaxNumber": "727-522-2222",
"EnumerationDate": "06/04/2019",
"LastUpdateDate": "08/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "2901023173",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DN25772",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}