{
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"NPI": "1255808283",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NTN DENTAL PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "26004 N KINGS MILL LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KINGWOOD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77339-2590",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-484-3435",
"MailingAddressFaxNumber": "281-645-4565",
"FirstLinePracticeLocationAddress": "10161 HIGHWAY 242",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "CONROE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77385",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-271-4456",
"PracticeLocationAddressFaxNumber": "936-271-4794",
"EnumerationDate": "10/29/2018",
"LastUpdateDate": "10/29/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "NGOC",
"AuthorizedOfficialMiddleName": "TUYET",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "503-484-3435",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}