{
"Npi": {
"NPI": "1578092748",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FABF MANAGEMENT, 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": "1708 SPRING GREEN BLVD STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KATY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77494-7463",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-492-1111",
"MailingAddressFaxNumber": "281-492-1131",
"FirstLinePracticeLocationAddress": "1708 SPRING GREEN BLVD #200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KATY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77494",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-492-1111",
"PracticeLocationAddressFaxNumber": "281-492-1131",
"EnumerationDate": "06/09/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AMADOR",
"AuthorizedOfficialFirstName": "TANYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "713-694-8800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "19674",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}