{
"Npi": {
"NPI": "1972177780",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ZIMMER",
"FirstName": "GABRIELA",
"MiddleName": "ALEJANDRA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "IBARRA",
"OtherFirstName": "GABRIELA",
"OtherMiddleName": "ALEJANDRA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "305 W. 12TH AVENUE",
"SecondLineMailingAddress": "3005R POSTLE HALL",
"MailingAddressCityName": "COLUMBUS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43210-5742",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-292-1097",
"MailingAddressFaxNumber": "614-247-8011",
"FirstLinePracticeLocationAddress": "305 W 12TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43210-1267",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-292-1097",
"PracticeLocationAddressFaxNumber": "614-247-8011",
"EnumerationDate": "05/17/2021",
"LastUpdateDate": "10/05/2022",
"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": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "D14651",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "30.026775",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}