{
"Npi": {
"NPI": "1639539430",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GEORGE XENAKIS, DDS, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "227 W VALLEY BLVD",
"SecondLineMailingAddress": "#238 ABC",
"MailingAddressCityName": "SAN GABRIEL",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91776-3764",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-300-8886",
"MailingAddressFaxNumber": "626-300-8855",
"FirstLinePracticeLocationAddress": "227 W VALLEY BLVD",
"SecondLinePracticeLocationAddress": "#238 ABC",
"PracticeLocationAddressCityName": "SAN GABRIEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91776-3764",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-300-8886",
"PracticeLocationAddressFaxNumber": "626-300-8855",
"EnumerationDate": "03/07/2016",
"LastUpdateDate": "03/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "XENAKIS",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "917-374-5082",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "64232",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}