{
"Npi": {
"NPI": "1750539276",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRINITY FAMILY DENTAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "800 N INDUSTRIAL BLVD",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "EULESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76039-7400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-283-3801",
"MailingAddressFaxNumber": "817-283-6309",
"FirstLinePracticeLocationAddress": "800 N INDUSTRIAL BLVD",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "EULESS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76039-7400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-283-3801",
"PracticeLocationAddressFaxNumber": "817-283-6309",
"EnumerationDate": "09/09/2008",
"LastUpdateDate": "09/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALIA",
"AuthorizedOfficialFirstName": "JASDEEP",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "GENERAL DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "817-283-3801",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "22368",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}