{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LIV DENTAL, PLLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "30003 SOUTHFIELD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHFIELD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48076-1433",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-646-2273",
"MailingAddressFaxNumber": "248-646-2434",
"FirstLinePracticeLocationAddress": "30003 SOUTHFIELD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHFIELD",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-646-2273",
"PracticeLocationAddressFaxNumber": "248-646-2434",
"EnumerationDate": "05/17/2016",
"LastUpdateDate": "05/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAHAL",
"AuthorizedOfficialFirstName": "MANPREET",
"AuthorizedOfficialMiddleName": "KAUR",
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"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "248-321-9726",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}