{
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"ParentOrgLBN": null,
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"MiddleName": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5225 N 19TH AVENUE",
"SecondLineMailingAddress": "#C",
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-433-0313",
"MailingAddressFaxNumber": "602-433-9343",
"FirstLinePracticeLocationAddress": "5225 N 19TH AVENUE",
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"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-433-0313",
"PracticeLocationAddressFaxNumber": "602-433-9343",
"EnumerationDate": "06/10/2008",
"LastUpdateDate": "06/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAY",
"AuthorizedOfficialFirstName": "MARC",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "602-433-0313",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "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."
}
}
}
}