{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ALIX PHILLIPS, DMD, INC.",
"LastName": null,
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"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "90 W CALLE DE LAS TIENDAS",
"SecondLineMailingAddress": "STE. 150",
"MailingAddressCityName": "GREEN VALLEY",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85614-4295",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-393-7500",
"MailingAddressFaxNumber": "520-399-0147",
"FirstLinePracticeLocationAddress": "90 W CALLE DE LAS TIENDAS",
"SecondLinePracticeLocationAddress": "STE. 150",
"PracticeLocationAddressCityName": "GREEN VALLEY",
"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-393-7500",
"PracticeLocationAddressFaxNumber": "520-399-0147",
"EnumerationDate": "11/08/2007",
"LastUpdateDate": "11/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHILLIPS",
"AuthorizedOfficialFirstName": "VIRGINIA",
"AuthorizedOfficialMiddleName": "ALIX",
"AuthorizedOfficialTitle": "DOCTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "520-393-7500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "3837",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}