{
"Npi": {
"NPI": "1679981757",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALPHA DENTAL GROUP",
"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": "4999 W 8TH AVE",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "HIALEAH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33012-3409",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-267-0218",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4999 W 8TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "HIALEAH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33012-3409",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-238-7406",
"PracticeLocationAddressFaxNumber": "786-238-7429",
"EnumerationDate": "08/01/2014",
"LastUpdateDate": "08/01/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOBADILLA",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "954-253-5998",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0700X",
"TaxonomyName": "Prosthodontics",
"LicenseNumber": "DN16956",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}