{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "SERVICIOS DENTALES DEL PUEBLO",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "JR 1 LIZZIE GRAHAM MARGINAL",
"SecondLineMailingAddress": "TMA SECC LEVITTOWN",
"MailingAddressCityName": "TOA BOJA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00949",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "JR 1 LIZZIE GRAHAM MARGINAL",
"SecondLinePracticeLocationAddress": "TMA SECC LEVITTOWN",
"PracticeLocationAddressCityName": "TOA BOJA",
"PracticeLocationAddressStateName": "PR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-784-1627",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/29/2011",
"LastUpdateDate": "06/29/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ORTEGA",
"AuthorizedOfficialFirstName": "GUILLERMO",
"AuthorizedOfficialMiddleName": "ROCAFORT",
"AuthorizedOfficialTitle": "DENTISTA",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "787-784-1627",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "2192",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}