{
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"OrgName": "PROHEALTH DENTISTS II PLLC",
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"FirstName": null,
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"FirstLineMailingAddress": "318 N HENRY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALEXANDRIA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22314-2439",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "571-335-5268",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4231 MARKHAM ST",
"SecondLinePracticeLocationAddress": "SUITE 214 A",
"PracticeLocationAddressCityName": "ANNANDALE",
"PracticeLocationAddressStateName": "VA",
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"EnumerationDate": "04/20/2016",
"LastUpdateDate": "04/20/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLAROS",
"AuthorizedOfficialFirstName": "CLAUDIA",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "571-335-5268",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "0443000020",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}