{
"Npi": {
"NPI": "1225543705",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KIDS HEALTHY SMILES 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": "2722 NE 1ST ST STE 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POMPANO BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33062-4934",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-590-8454",
"MailingAddressFaxNumber": "754-220-6162",
"FirstLinePracticeLocationAddress": "2722 NE 1ST ST STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POMPANO BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33062-4934",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-590-8454",
"PracticeLocationAddressFaxNumber": "754-220-6162",
"EnumerationDate": "12/06/2017",
"LastUpdateDate": "12/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRANADA RAMIREZ",
"AuthorizedOfficialFirstName": "ERIKA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "954-590-8454",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}