{
"Npi": {
"NPI": "1982710141",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EDGE",
"FirstName": "DIANE",
"MiddleName": "LESLIE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1012 ISABELLA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONADO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92118-2820",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-435-0147",
"MailingAddressFaxNumber": "619-435-0478",
"FirstLinePracticeLocationAddress": "1012 ISABELLA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORONADO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92118-2820",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-435-0147",
"PracticeLocationAddressFaxNumber": "619-435-0478",
"EnumerationDate": "08/21/2006",
"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": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "031602",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}