{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "RESTORATION DENTAL GROUP LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "7607 FERN AVE. SUITE 800",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-797-1181",
"MailingAddressFaxNumber": "318-797-1180",
"FirstLinePracticeLocationAddress": "2010 E 70TH ST",
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"PracticeLocationAddressCityName": "SHREVEPORT",
"PracticeLocationAddressStateName": "LA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-797-1181",
"PracticeLocationAddressFaxNumber": "318-797-1180",
"EnumerationDate": "06/02/2010",
"LastUpdateDate": "07/15/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JARVIS",
"AuthorizedOfficialFirstName": "RAYMOND",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER OF RESTORATION DENTAL GROUP L",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "318-797-1181",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}