{
"Npi": {
"NPI": "1346984689",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PABLO ACUNA DENTAL GROUP, LLC",
"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": "31 ELMBROOK PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLOOMFIELD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07003-3114",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-600-2505",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "180 WASHINGTON AVE FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELLEVILLE",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07109-2541",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-600-2505",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/22/2022",
"LastUpdateDate": "06/09/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ACUNA",
"AuthorizedOfficialFirstName": "PABLO",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "973-600-2505",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}