{
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"IsOrgSubpart": "N",
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"OrgName": "SMILE 360 PLLC",
"LastName": null,
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"FirstLineMailingAddress": "1509 S. LAMAR BLVD #675",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AUSTIN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78704",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-444-4746",
"MailingAddressFaxNumber": "512-442-4750",
"FirstLinePracticeLocationAddress": "1509 S LAMAR BLVD",
"SecondLinePracticeLocationAddress": "SUITE 675",
"PracticeLocationAddressCityName": "AUSTIN",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressTelephoneNumber": "512-444-4746",
"PracticeLocationAddressFaxNumber": "512-442-4750",
"EnumerationDate": "02/21/2012",
"LastUpdateDate": "05/16/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IP",
"AuthorizedOfficialFirstName": "VINCENT",
"AuthorizedOfficialMiddleName": "KING",
"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "512-814-2084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "22901",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}