{
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"EIN": null,
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"OrgName": "EMPIRE DENTISTRY PLLC",
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"NameSuffix": null,
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"FirstLineMailingAddress": "5509 PLEASANT VALLEY DR",
"SecondLineMailingAddress": "90A",
"MailingAddressCityName": "PLANO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75023-5248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-313-3057",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5509 PLEASANT VALLEY DR",
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"PracticeLocationAddressCityName": "PLANO",
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"EnumerationDate": "07/15/2015",
"LastUpdateDate": "07/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAIK",
"AuthorizedOfficialFirstName": "MUHIBUNNISA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DDS/DENTIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "28693",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}