{
"Npi": {
"NPI": "1609127356",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTRE FOR DIAGNOSTIC AND COSMETIC DENTISTRY, PLLC",
"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": "5501 INDEPENDENCE PKWY",
"SecondLineMailingAddress": "SUITE 107",
"MailingAddressCityName": "PLANO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75023-5463",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-964-5928",
"MailingAddressFaxNumber": "972-612-4498",
"FirstLinePracticeLocationAddress": "5501 INDEPENDENCE PKWY",
"SecondLinePracticeLocationAddress": "SUITE 107",
"PracticeLocationAddressCityName": "PLANO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75023-5463",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-612-4498",
"PracticeLocationAddressFaxNumber": "972-612-4498",
"EnumerationDate": "09/20/2012",
"LastUpdateDate": "12/07/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWE",
"AuthorizedOfficialFirstName": "REGINA",
"AuthorizedOfficialMiddleName": "DENISE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "972-612-9948",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "16450",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}