{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "EDUARDO CORREA D.D.S., INC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "744 E CHAPMAN AVE",
"SecondLineMailingAddress": "#5",
"MailingAddressCityName": "ORANGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92866-1621",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-538-5582",
"MailingAddressFaxNumber": "714-538-5589",
"FirstLinePracticeLocationAddress": "744 E CHAPMAN AVE",
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"PracticeLocationAddressCityName": "ORANGE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-538-5582",
"PracticeLocationAddressFaxNumber": "714-538-5589",
"EnumerationDate": "09/07/2010",
"LastUpdateDate": "09/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORREA",
"AuthorizedOfficialFirstName": "EDUARDO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "714-538-5582",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "53901",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}