{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "HABIBI & MIRDAMADI D.D.S, PA.",
"LastName": null,
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"FirstLineMailingAddress": "18218 FLOWER HILL WAY",
"SecondLineMailingAddress": "DENTAL SUITE HABIBI AND MIRDAMADI, D.D.S., P.A.",
"MailingAddressCityName": "GAITHERSBURG",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20879",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-963-0665",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18218 FLOWER HILL WAY",
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"PracticeLocationAddressCityName": "GAITHERSBURG",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-963-0665",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/07/2008",
"LastUpdateDate": "08/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIRDAMADI",
"AuthorizedOfficialFirstName": "BEHZAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "301-963-0665",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "9867",
"LicenseNumberStateCode": "MD",
"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."
}
}
}
}