{
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"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "12333 35TH AVE NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEATTLE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98125-5600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-363-8800",
"MailingAddressFaxNumber": "206-363-4208",
"FirstLinePracticeLocationAddress": "12333 35TH AVE NE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SEATTLE",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-363-8800",
"PracticeLocationAddressFaxNumber": "206-363-4208",
"EnumerationDate": "06/03/2016",
"LastUpdateDate": "12/17/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JERE",
"AuthorizedOfficialFirstName": "DEEPALI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PARTNER DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "425-615-4685",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}