{
"Npi": {
"NPI": "1992962732",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EASTERN IOWA ORAL AND MAXILLOFACIAL SURGERY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4150 EDGEWOOD ROAD NE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "CEDAR RAPIDS",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52402-0609",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-366-8277",
"MailingAddressFaxNumber": "319-366-7091",
"FirstLinePracticeLocationAddress": "4150 EDGEWOOD ROAD NE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "CEDAR RAPIDS",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "52402-0609",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "319-366-8277",
"PracticeLocationAddressFaxNumber": "319-366-7091",
"EnumerationDate": "05/20/2008",
"LastUpdateDate": "12/28/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEWART",
"AuthorizedOfficialFirstName": "SUZANNE",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "319-366-8277",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "08986",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}