{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JARED WEISS DDS, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "2981 E AVENIDA DE LOS ARBOLES",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THOUSAND OAKS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91362-4926",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-447-2444",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "176 AUBURN CT STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTLAKE VILLAGE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91362-3675",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-447-2444",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/16/2020",
"LastUpdateDate": "07/16/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEISS",
"AuthorizedOfficialFirstName": "JARED",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "818-447-2444",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}