{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "SNOHOMISH FAMILY DENTAL CARE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1322 AVENUE D",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "SNOHOMISH",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98290-1746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1322 AVENUE D",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "SNOHOMISH",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-568-5800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/22/2015",
"LastUpdateDate": "12/22/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AWLA",
"AuthorizedOfficialFirstName": "DAMAN",
"AuthorizedOfficialMiddleName": "K",
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"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "360-568-5800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251K00000X",
"TaxonomyName": "Public Health or Welfare Agency",
"LicenseNumber": "DE60384654",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}