{
"Npi": {
"NPI": "1942665377",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMPLETE DENTAL SOLUTION OF LIMERICK LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "292 W.RIDGE PIKE",
"SecondLineMailingAddress": "BUILDING B, 2ND FL",
"MailingAddressCityName": "LIMERICK",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19468",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "292 W RIDGE PIKE",
"SecondLinePracticeLocationAddress": "BUILDING B, 2ND FL",
"PracticeLocationAddressCityName": "LIMERICK",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19468-3716",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-308-6609",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/30/2015",
"LastUpdateDate": "12/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATSON",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "610-308-6609",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DS027446-L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}