{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ORAL & FACIAL SURGERY CENTER OF TALLAHASSEE, P.A.",
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"NameSuffix": null,
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"FirstLineMailingAddress": "1702 RIGGINS RD",
"SecondLineMailingAddress": "SUITE 1 & 2",
"MailingAddressCityName": "TALLAHASSEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32308-5371",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-386-4602",
"MailingAddressFaxNumber": "850-386-4206",
"FirstLinePracticeLocationAddress": "3375 CAPITAL CIRCLE NE BLDG D",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "TALLAHASSEE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32308-4334",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-386-4602",
"PracticeLocationAddressFaxNumber": "850-386-4206",
"EnumerationDate": "10/29/2009",
"LastUpdateDate": "10/29/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOLLEY",
"AuthorizedOfficialFirstName": "BARRETT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "850-386-4602",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}