{"npi":"1902017593","type":"NPI-2","status":"active","name":{"display":"South Bend Smiles Youth Dentistry, LLC","other":[],"organization_name":"SOUTH BEND SMILES YOUTH DENTISTRY, LLC","authorised_official":"Jenell Stump"},"specialty":{"primary_taxonomy":"1223G0001X","primary_taxonomy_description":"General Practice Dentistry","slug":"general-practice-dentistry","schema_org_specialty":null,"all":[{"code":"1223G0001X","description":"General Practice Dentistry","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2332 MIRACLE LN","city":"MISHAWAKA","state":"IN","postal_code":"465453012","country_code":"US","phone":"5742595437","fax":"5742595438"},{"purpose":"MAILING","street_1":"16 ARCADE UNIT 198747","city":"NASHVILLE","state":"TN","postal_code":"372191994","country_code":"US","phone":"6157500343","fax":"6159861705"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"200828710A","state":"IN","issuer":null},{"type_code":"05","label":"Medicaid","value":"1902017593","state":"MI","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2007-05-24","last_updated":"2014-07-09","_meta":{"source":"NPPES","snapshot_date":"2014-07-09","doc_url":"https://findmynpi.com/api"}}