{
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"OrgName": "VIENNA PERIODONTICS",
"LastName": null,
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"FirstLineMailingAddress": "301 MAPLE AVE W",
"SecondLineMailingAddress": "#440",
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"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22180-4301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-539-9215",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "301 MAPLE AVE W",
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"PracticeLocationAddressTelephoneNumber": "703-539-9215",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/17/2016",
"LastUpdateDate": "05/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OH",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "703-539-9215",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "0401412796",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}