{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "SEYED M. SHAMSEDDIN, DDS, LLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "9002 LINCOLN DR W",
"SecondLineMailingAddress": "SUITE H",
"MailingAddressCityName": "MARLTON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08053-3204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-983-3450",
"MailingAddressFaxNumber": "856-983-9877",
"FirstLinePracticeLocationAddress": "9002 LINCOLN DR W STE H",
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"PracticeLocationAddressCityName": "MARLTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-983-3450",
"PracticeLocationAddressFaxNumber": "856-983-9877",
"EnumerationDate": "08/14/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAMSEDDIN",
"AuthorizedOfficialFirstName": "SEYED",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "856-983-3450",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Periodontics",
"LicenseNumber": "22DI02035800",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}