{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR. PATRICIA REATEGUI D.D.S.P.C.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 279",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STAFFORD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22555-0279",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-659-6650",
"MailingAddressFaxNumber": "540-657-0576",
"FirstLinePracticeLocationAddress": "623 GARRISONVILLE RD",
"SecondLinePracticeLocationAddress": "623 GARRISONVILLE ROAD",
"PracticeLocationAddressCityName": "STAFFORD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22554-3710",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-659-6650",
"PracticeLocationAddressFaxNumber": "540-657-0576",
"EnumerationDate": "03/19/2014",
"LastUpdateDate": "06/09/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REATEGUI",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.P.C.",
"AuthorizedOfficialTelephoneNumber": "540-659-6650",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0401413627",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}