{
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"IsOrgSubpart": "N",
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"OrgName": "NEIGHBORHOOD DENTAL SERVICES OF NWA, PLLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "1104 POPLAR PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROGERS",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72756-4249",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-619-9052",
"MailingAddressFaxNumber": "479-636-5154",
"FirstLinePracticeLocationAddress": "1909 E CENTRAL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENTONVILLE",
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"PracticeLocationAddressPostalCode": "72712-5601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-273-9302",
"PracticeLocationAddressFaxNumber": "479-268-4630",
"EnumerationDate": "02/19/2012",
"LastUpdateDate": "02/19/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAHON",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "THOMAS",
"AuthorizedOfficialTitle": "MANAGER AND SOLE MEMBER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "479-619-9052",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "2401",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}