{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KM DENTAL LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5051 E CAMINO BOSQUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUCSON",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85718-4613",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-360-3012",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2471 N COUNTRY CLUB RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUCSON",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85716-2503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-327-5661",
"PracticeLocationAddressFaxNumber": "520-325-6557",
"EnumerationDate": "02/14/2022",
"LastUpdateDate": "02/14/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MASKELL",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": "THOMAS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "520-360-3012",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}