{
"Npi": {
"NPI": "1366560716",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FARIBA RAFIZADEH, D.M.D. P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "902 WIND RIVER LN STE 204",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GAITHERSBURG",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20878-1977",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-948-5656",
"MailingAddressFaxNumber": "301-519-9164",
"FirstLinePracticeLocationAddress": "902 WIND RIVER LN STE 204",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GAITHERSBURG",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20878-1977",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-948-5656",
"PracticeLocationAddressFaxNumber": "301-519-9164",
"EnumerationDate": "03/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAFIZADEH",
"AuthorizedOfficialFirstName": "FARIBA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "301-948-5656",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "12428",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}