{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DENTAL ADVANTAGE SOUTH 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": "8650 CORAL WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33155-2338",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-379-8019",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "33497 S DIXIE HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLORIDA CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33034-5642",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-874-7509",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/11/2022",
"LastUpdateDate": "01/11/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VELAZQUEZ",
"AuthorizedOfficialFirstName": "LEIRY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "786-379-8019",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}