{
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"EIN": null,
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"IsOrgSubpart": "Y",
"ParentOrgLBN": "MARYJANE L. FUSTER DMD APC",
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"FirstLineMailingAddress": "53 MARYLINN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILPITAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95035-4311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "408-934-0391",
"MailingAddressFaxNumber": "408-934-0398",
"FirstLinePracticeLocationAddress": "53 MARYLINN DRIVE",
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"PracticeLocationAddressCityName": "MILPITAS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "408-934-0391",
"PracticeLocationAddressFaxNumber": "408-934-0398",
"EnumerationDate": "09/29/2009",
"LastUpdateDate": "09/29/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FUSTER",
"AuthorizedOfficialFirstName": "MARYJANE",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "408-934-0391",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "43786",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}