{
"Npi": {
"NPI": "1710420625",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THAILONG TRAN DDS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14207 PARK CENTER DR",
"SecondLineMailingAddress": "STE 105",
"MailingAddressCityName": "LAUREL",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20707-5248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-776-9686",
"MailingAddressFaxNumber": "301-776-9680",
"FirstLinePracticeLocationAddress": "14207 PARK CENTER DR",
"SecondLinePracticeLocationAddress": "STE 105",
"PracticeLocationAddressCityName": "LAUREL",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20707-5248",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-776-9686",
"PracticeLocationAddressFaxNumber": "301-776-9680",
"EnumerationDate": "11/25/2016",
"LastUpdateDate": "11/25/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRAN",
"AuthorizedOfficialFirstName": "THAILONG",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "301-776-9686",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "16183",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}