{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOOD VIBES DENTISTRY LLC",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "737 BAINBRIDGE ST # 7300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19147-2058",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-901-2655",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "232 DOVE RUN CENTRE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLETOWN",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19709-7971",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-449-6810",
"PracticeLocationAddressFaxNumber": "302-449-6222",
"EnumerationDate": "03/06/2023",
"LastUpdateDate": "03/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "URAM",
"AuthorizedOfficialFirstName": "JACOB",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "215-901-2655",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}