{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "AD ASTRA FAMILY DENTISTRY, L.L.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5963 SW 31ST TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOPEKA",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66614-4123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "785-286-7541",
"MailingAddressFaxNumber": "785-783-2962",
"FirstLinePracticeLocationAddress": "1271 SW WOODHULL ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOPEKA",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "66604-1849",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "785-286-7541",
"PracticeLocationAddressFaxNumber": "785-783-2962",
"EnumerationDate": "12/07/2016",
"LastUpdateDate": "12/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "785-220-6346",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "60471",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}