{
"Npi": {
"NPI": "1285016022",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEHBE",
"FirstName": "HAITHAM",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19804 MORRIS AVE",
"SecondLineMailingAddress": "STE 130",
"MailingAddressCityName": "MANVEL",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77578-2867",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "216-410-2805",
"MailingAddressFaxNumber": "440-884-4393",
"FirstLinePracticeLocationAddress": "19804 MORRIS AVE,",
"SecondLinePracticeLocationAddress": "STE 130",
"PracticeLocationAddressCityName": "MANVEL",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77578",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-410-2805",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/28/2015",
"LastUpdateDate": "06/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "30024516",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}