{
"Npi": {
"NPI": "1053847947",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "O. EL HILLAL DMD, MS DENTAL CORP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8272 W LAKE PLEASANT PKWY STE 209",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEORIA",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85382-7432",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-376-6464",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "33 CREEK RD",
"SecondLinePracticeLocationAddress": "SUITE 280",
"PracticeLocationAddressCityName": "IRVINE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92604-4791",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-551-4540",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/11/2017",
"LastUpdateDate": "05/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EL-HILLAL",
"AuthorizedOfficialFirstName": "OUSAMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD, MS",
"AuthorizedOfficialTelephoneNumber": "623-376-6464",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "DDS100864",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}