{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "DADE COUNTY DENTAL RESEARCH CENTER",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "750 NW 20TH ST # G-110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33127-4618",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "750 NW 20TH ST # G-110",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIAMI",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-363-2218",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/10/2015",
"LastUpdateDate": "03/23/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALVAREZ",
"AuthorizedOfficialFirstName": "MARIO",
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"AuthorizedOfficialCredential": "COO",
"AuthorizedOfficialTelephoneNumber": "305-363-2218",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "DN14199",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}