{
  "npi": "1215755004",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "JENNIFER",
    "authorized_official_last_name": "ROGERS",
    "authorized_official_middle_name": "JORDAN",
    "authorized_official_telephone_number": "4708014637",
    "authorized_official_title_or_position": "Credentialing Specialist",
    "certification_date": "2026-08-03",
    "enumeration_date": "2024-09-30",
    "last_updated": "2026-08-03",
    "organization_name": "CHILDREN AND TEEN DENTAL GROUP",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "CHILDREN AND TEEN DENTAL GROUP",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "2300 LAKEVIEW PKWY STE 250",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "ALPHARETTA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "300093954",
      "state": "GA",
      "telephone_number": "470-750-4866"
    },
    {
      "address_1": "320 BENJAMIN H HILL DR SW",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "FITZGERALD",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "317508694",
      "state": "GA",
      "telephone_number": "229-423-9471"
    }
  ],
  "taxonomies": [
    {
      "code": "122300000X",
      "desc": "Dentist",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "1223G0001X",
      "desc": "Dentist, General Practice",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "1223P0221X",
      "desc": "Dentist, Pediatric Dentistry",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)",
    "certifying_board": "American Dental Association (ADA) / State Board of Dental Examiners",
    "cms_medicare_crosswalk": []
  }
}