{
"Npi": {
"NPI": "1982918884",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MATCHSTICK LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3600 VAWTER SCHOOL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65203-9418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-445-1100",
"MailingAddressFaxNumber": "573-445-1153",
"FirstLinePracticeLocationAddress": "2401 BERNADETTE DR",
"SecondLinePracticeLocationAddress": "SUITE 217",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65203-4672",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-445-1100",
"PracticeLocationAddressFaxNumber": "573-445-1153",
"EnumerationDate": "08/03/2010",
"LastUpdateDate": "08/03/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GADBOIS",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "VIRGINIA",
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "573-446-0880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "2009013643",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}