{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIGHLAND FAMILY DENTAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "229 HIGHLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERBURY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06708-3055",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-755-5431",
"MailingAddressFaxNumber": "203-756-6089",
"FirstLinePracticeLocationAddress": "229 HIGHLAND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WATERBURY",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-755-5431",
"PracticeLocationAddressFaxNumber": "203-756-6089",
"EnumerationDate": "06/23/2022",
"LastUpdateDate": "11/07/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAW",
"AuthorizedOfficialFirstName": "HAI YAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "203-755-5431",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}