{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "PAOLA MARIEL WAINBERG P.A.",
"LastName": null,
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"NameSuffix": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "8060 W MCNAB RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LAUDERDALE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33068-4254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-720-9707",
"MailingAddressFaxNumber": "954-720-9705",
"FirstLinePracticeLocationAddress": "8060 W MC NAB RD",
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"PracticeLocationAddressCityName": "NORTH LAUDERDALE",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-720-9707",
"PracticeLocationAddressFaxNumber": "954-720-9705",
"EnumerationDate": "03/22/2018",
"LastUpdateDate": "03/22/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WAINBERG",
"AuthorizedOfficialFirstName": "PAOLA",
"AuthorizedOfficialMiddleName": "MARIEL",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "954-720-9707",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN22827",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}