{
  "npi": "1730236894",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "HEATHER",
    "authorized_official_last_name": "BURTON",
    "authorized_official_middle_name": "R.",
    "authorized_official_name_prefix": "Mrs.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "5734467181",
    "authorized_official_title_or_position": "Office Manager",
    "certification_date": "2021-09-16",
    "enumeration_date": "2007-01-04",
    "last_updated": "2021-09-16",
    "organization_name": "ACCENT DENTAL CENTER ON FORUM, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1401 FORUM BLVD",
      "address_2": "STE. 203",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "COLUMBIA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "573-446-1770",
      "postal_code": "652031915",
      "state": "MO",
      "telephone_number": "573-446-7181"
    },
    {
      "address_1": "1401 FORUM BLVD",
      "address_2": "STE. 203",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "COLUMBIA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "573-446-1770",
      "postal_code": "652031915",
      "state": "MO",
      "telephone_number": "573-446-7181"
    }
  ],
  "taxonomies": [
    {
      "code": "122300000X",
      "desc": "Dentist",
      "license": "2003011293",
      "primary": false,
      "state": "MO",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "1223P0221X",
      "desc": "Dentist, Pediatric Dentistry",
      "license": "010435",
      "primary": false,
      "state": "MO",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "1223X2210X",
      "desc": "Dentist, Orofacial Pain",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "332B00000X",
      "desc": "Durable Medical Equipment & Medical Supplies",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "1223S0112X",
      "desc": "Dentist, Oral and Maxillofacial Surgery",
      "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": [
      {
        "medicare_code": "19",
        "medicare_type": "Oral Surgery (Dentist only)"
      }
    ]
  }
}