{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AFRA DENTAL GROUP, APC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "25551 CHIMERA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MISSION VIEJO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92692-5048",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-324-3248",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "650 S LINCOLN AVE STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92882-3540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-372-0440",
"PracticeLocationAddressFaxNumber": "951-372-0660",
"EnumerationDate": "09/18/2025",
"LastUpdateDate": "09/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KHOSHSAR",
"AuthorizedOfficialFirstName": "RAMIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "818-324-3248",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}