{
"Npi": {
"NPI": "1629422597",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED ORAL SURGERY & IMPLANT CENTER P.C.",
"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": "7200 DAN HOEY RD",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "DEXTER",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48130-4201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7200 DAN HOEY RD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DEXTER",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48130-4201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-726-0760",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/18/2016",
"LastUpdateDate": "04/18/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SALAMEN",
"AuthorizedOfficialFirstName": "OMAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ORAL & MAXILLOFACIAL SURGEON",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "734-726-0760",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery Clinic/Center",
"LicenseNumber": "2901018852",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}