{
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"EIN": null,
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"IsOrgSubpart": "N",
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"MiddleName": null,
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"FirstLineMailingAddress": "8725 MARBACH RD",
"SecondLineMailingAddress": "237",
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78227-2376",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-627-6305",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10842 POTRANCO RD",
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"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78251-3307",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-607-6453",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/04/2014",
"LastUpdateDate": "11/04/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREWAL",
"AuthorizedOfficialFirstName": "PRABHDEEP",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWENER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "210-607-6453",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "27735",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}