{
  "npi": "1730276411",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "RDH",
    "authorized_official_first_name": "DOLLIE",
    "authorized_official_last_name": "BLACK",
    "authorized_official_middle_name": "M",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2697314581",
    "authorized_official_title_or_position": "Director",
    "enumeration_date": "2006-10-06",
    "last_updated": "2020-08-22",
    "organization_name": "TOOTH TIME",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "7057 STONEY CREEK DR",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "AUGUSTA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "490128883",
      "state": "MI",
      "telephone_number": "269-731-4581"
    },
    {
      "address_1": "7057 STONEY CREEK DR",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "AUGUSTA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "490128883",
      "state": "MI",
      "telephone_number": "269-731-4581"
    }
  ],
  "taxonomies": [
    {
      "code": "1223D0001X",
      "desc": "Dentist, Dental Public Health",
      "license": "2901017274",
      "primary": true,
      "state": "MI",
      "taxonomy_group": "193400000X - Single 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": []
  }
}