{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PESSAH DENTAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 920050",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75392-0050",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-845-8500",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12214 LAKEWOOD BLVD STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DOWNEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90242-2663",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-273-2050",
"PracticeLocationAddressFaxNumber": "562-247-9788",
"EnumerationDate": "09/26/2019",
"LastUpdateDate": "08/05/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PESSAH",
"AuthorizedOfficialFirstName": "ARIELLA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "GP/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "562-273-2050",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}