{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9709 NORTHEAST PKWY",
"SecondLineMailingAddress": "#100",
"MailingAddressCityName": "MATTHEWS",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28105-9705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-845-0500",
"MailingAddressFaxNumber": "704-814-0125",
"FirstLinePracticeLocationAddress": "9709 NORTHEAST PKWY",
"SecondLinePracticeLocationAddress": "#100",
"PracticeLocationAddressCityName": "MATTHEWS",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-845-0500",
"PracticeLocationAddressFaxNumber": "704-814-0125",
"EnumerationDate": "02/17/2016",
"LastUpdateDate": "02/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NABA",
"AuthorizedOfficialFirstName": "BUTHAYNA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "704-845-0500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "9618",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}