{
"Npi": {
"NPI": "1962605675",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MILES",
"FirstName": "ETHEL",
"MiddleName": "MARLENE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.D.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GREENE",
"OtherFirstName": "ETHEL",
"OtherMiddleName": "MARLENE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.D.S.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "5 FISCELLA CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMPTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23669-1865",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-851-5549",
"MailingAddressFaxNumber": "757-851-5549",
"FirstLinePracticeLocationAddress": "425 W 20TH ST",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "NORFOLK",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23517-2128",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-622-4245",
"PracticeLocationAddressFaxNumber": "757-622-3722",
"EnumerationDate": "06/08/2007",
"LastUpdateDate": "07/08/2007",
"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": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0401 006823",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "50053477",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "63226209921",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}