{
"Npi": {
"NPI": "1962850701",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GROSKOPF",
"FirstName": "KELLY",
"MiddleName": "GRUETZMACHER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.D.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GRUETZMACHER",
"OtherFirstName": "KELLY",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.D.S.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1951 COMMERCE PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT ATKINSON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53538-3139",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-563-4415",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "W381N8165 ROLLING RIVER CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCONOMOWOC",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53066-8950",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-459-3222",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/02/2016",
"LastUpdateDate": "03/03/2017",
"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": "1001308-15",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}