{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAKOTA DENTAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2605 19TH AVE W",
"SecondLineMailingAddress": "SUITE 102",
"MailingAddressCityName": "WILLISTON",
"MailingAddressStateName": "ND",
"MailingAddressPostalCode": "58801-2892",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "701-577-3333",
"MailingAddressFaxNumber": "701-577-3336",
"FirstLinePracticeLocationAddress": "2605 19TH AVE W",
"SecondLinePracticeLocationAddress": "SUITE 102",
"PracticeLocationAddressCityName": "WILLISTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "701-577-3333",
"PracticeLocationAddressFaxNumber": "701-577-3336",
"EnumerationDate": "09/18/2014",
"LastUpdateDate": "06/20/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACKHURST",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "701-577-3333",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
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"LicenseNumber": "2209",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "261QD0000X",
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"LicenseNumber": "2210",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}