{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTWEST FAMILY DENTAL, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "301 E LOHMAN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS CRUCES",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88001-3667",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "575-524-4900",
"MailingAddressFaxNumber": "575-524-8300",
"FirstLinePracticeLocationAddress": "301 E LOHMAN AVE",
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"PracticeLocationAddressCityName": "LAS CRUCES",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88001-3667",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "575-524-4900",
"PracticeLocationAddressFaxNumber": "575-524-8300",
"EnumerationDate": "04/29/2008",
"LastUpdateDate": "04/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REITER",
"AuthorizedOfficialFirstName": "HARVEY",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "575-541-0072",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DD2601",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}