{
"Npi": {
"NPI": "1144152067",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TASSABHJI",
"FirstName": "RADWAN",
"MiddleName": "MONZER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4428 RED BARN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHARDSON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75082-2680",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-616-1775",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "860 E HIGHWAY 114 STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROANOKE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76262-6713",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-491-3000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/03/2026",
"LastUpdateDate": "07/02/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "42682",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}