{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AVENUE DENTAL LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "983 PEACHTREE PARKWAY SUITE C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CUMMING",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30041",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-888-4444",
"MailingAddressFaxNumber": "770-888-4448",
"FirstLinePracticeLocationAddress": "983 PEACHTREE PARKWAY SUITE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CUMMING",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-888-4444",
"PracticeLocationAddressFaxNumber": "770-888-4448",
"EnumerationDate": "02/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUDEIR",
"AuthorizedOfficialFirstName": "MOUHANNAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "770-888-4444",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DN013053",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}