{
"Npi": {
"NPI": "1114608965",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR MOSQUERA PROSTHODONTICS PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3500 SANDPIPER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62711-6722",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-635-8018",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "687 E LINTON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62703-5902",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-909-2550",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/25/2023",
"LastUpdateDate": "07/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOSQUERA CASTRILLON",
"AuthorizedOfficialFirstName": "JORGE",
"AuthorizedOfficialMiddleName": "ENRIQUE",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "561-635-8018",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}