{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
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"OrgName": "SABET DENTAL CORP.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5304 W CENTURY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90045-5910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-215-1455",
"MailingAddressFaxNumber": "310-215-1460",
"FirstLinePracticeLocationAddress": "5304 W CENTURY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-215-1455",
"PracticeLocationAddressFaxNumber": "310-215-1460",
"EnumerationDate": "10/24/2007",
"LastUpdateDate": "10/24/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITCHELL",
"AuthorizedOfficialFirstName": "DANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BUSINESS MANAGER",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-215-1455",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "38223",
"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."
}
}
}
}