{
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"OrgName": "A BETTER SMILE DENTISTRY LLC",
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"FirstLineMailingAddress": "475 COORS BLVD NW",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-548-5959",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "475 COORS BLVD NW",
"SecondLinePracticeLocationAddress": "SUITE A",
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"PracticeLocationAddressTelephoneNumber": "505-208-0505",
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"EnumerationDate": "02/13/2017",
"LastUpdateDate": "08/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAO",
"AuthorizedOfficialFirstName": "LI",
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"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "505-208-0505",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "DD4029",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}