{
"Npi": {
"NPI": "1295977015",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENTAL ASSOCIATES OF BAL HARBOUR",
"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": "10545 SW 74TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PINECREST",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33156-3882",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-512-3187",
"MailingAddressFaxNumber": "305-740-9507",
"FirstLinePracticeLocationAddress": "260 95TH ST",
"SecondLinePracticeLocationAddress": "SUITE 209",
"PracticeLocationAddressCityName": "SURFSIDE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33154-2807",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-866-8290",
"PracticeLocationAddressFaxNumber": "305-866-8298",
"EnumerationDate": "03/25/2009",
"LastUpdateDate": "03/25/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORPAS",
"AuthorizedOfficialFirstName": "ALFREDO",
"AuthorizedOfficialMiddleName": "DOMINGO",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "786-512-3178",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DN0013451",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}