{
"Npi": {
"NPI": "1215332077",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLENN L. DOMINGUEZ, D.M.D., LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2345 MENDON RD STE 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOONSOCKET",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02895-6164",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-766-9090",
"MailingAddressFaxNumber": "401-766-9070",
"FirstLinePracticeLocationAddress": "2345 MENDON RD STE 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WOONSOCKET",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02895-6164",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-766-9090",
"PracticeLocationAddressFaxNumber": "401-766-9070",
"EnumerationDate": "10/22/2014",
"LastUpdateDate": "01/19/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOMINGUEZ",
"AuthorizedOfficialFirstName": "GLENN",
"AuthorizedOfficialMiddleName": "LEGASPI",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "401-766-9122",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DEN02402",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}