{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "LUCAS J. NAZARIO-CORREA, D.M.D., P.A.",
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"FirstLineMailingAddress": "1006 LYNDHURST FALLS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KNIGHTDALE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27545-9716",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-295-4694",
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"FirstLinePracticeLocationAddress": "6406 MCCRIMMON PKWY",
"SecondLinePracticeLocationAddress": "SUITE 220",
"PracticeLocationAddressCityName": "MORRISVILLE",
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"EnumerationDate": "04/15/2010",
"LastUpdateDate": "04/15/2010",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NAZARIO",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "8294",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}