{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SABETHA DENTAL LLC",
"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": "1309 S US OLD HIGHWAY 75",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SABETHA",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66534",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "785-284-2323",
"MailingAddressFaxNumber": "785-284-0075",
"FirstLinePracticeLocationAddress": "1309 S US OLD HIGHWAY 75",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SABETHA",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "66534",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "785-284-2323",
"PracticeLocationAddressFaxNumber": "785-284-0075",
"EnumerationDate": "06/22/2021",
"LastUpdateDate": "07/31/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TEDMAN",
"AuthorizedOfficialFirstName": "ELIZABETH",
"AuthorizedOfficialMiddleName": "LOUISE",
"AuthorizedOfficialTitle": "DENTIST-OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "785-284-2323",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}