{
"Npi": {
"NPI": "1235673740",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMBASSADOR PRACTICE MANAGEMENT, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "123 GROVE AVE",
"SecondLineMailingAddress": "#101",
"MailingAddressCityName": "CEDARHURST",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11516-2322",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-503-1607",
"MailingAddressFaxNumber": "425-671-0756",
"FirstLinePracticeLocationAddress": "104 W OAK HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTMINSTER",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29693-2226",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-647-9000",
"PracticeLocationAddressFaxNumber": "425-671-0756",
"EnumerationDate": "12/19/2016",
"LastUpdateDate": "12/19/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AUGENBAUM",
"AuthorizedOfficialFirstName": "NACHUM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER / MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "864-647-9000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "3059",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}