{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ORLY TAITZ, INC",
"LastName": null,
"FirstName": null,
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"FirstLineMailingAddress": "29839 SANTA MARGARITA",
"SecondLineMailingAddress": "STE 100",
"MailingAddressCityName": "RANCO SANTA MARGARITA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92688",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-766-7687",
"MailingAddressFaxNumber": "949-766-7603",
"FirstLinePracticeLocationAddress": "29839 SANTA MARGARITA PKWY STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RANCHO SANTA MARGARITA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92688-3616",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-766-7687",
"PracticeLocationAddressFaxNumber": "949-766-7603",
"EnumerationDate": "07/24/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAITZ",
"AuthorizedOfficialFirstName": "ORLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT OF CORP.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "949-683-5411",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "37934",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}