{
"Npi": {
"NPI": "1619334463",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PLAZA DENTAL CENTER PA",
"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": "4140 LEGACY DR",
"SecondLineMailingAddress": "SUITE 302",
"MailingAddressCityName": "PLANO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75024-3495",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-208-9998",
"MailingAddressFaxNumber": "972-208-9995",
"FirstLinePracticeLocationAddress": "4140 LEGACY DR",
"SecondLinePracticeLocationAddress": "SUITE 302",
"PracticeLocationAddressCityName": "PLANO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75024-3495",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-208-9998",
"PracticeLocationAddressFaxNumber": "972-208-9995",
"EnumerationDate": "01/25/2016",
"LastUpdateDate": "01/25/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WENG",
"AuthorizedOfficialFirstName": "BIN",
"AuthorizedOfficialMiddleName": "X",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "972-208-9998",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "18039",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}