{
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"IsOrgSubpart": "N",
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"OrgName": "ARTEAGA DENTAL CORPORATION",
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"FirstLineMailingAddress": "228 W BASE LINE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIALTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92376-3306",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "494 S RANCHO AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN BERNARDINO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "909-875-8930",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/04/2018",
"LastUpdateDate": "09/04/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ARTEAGA",
"AuthorizedOfficialFirstName": "ANAMARIA",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "909-875-8930",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "48222",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}