{
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"IsOrgSubpart": "N",
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"OrgName": "OAK RIDGE DENTAL PLLC",
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"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2717 PECAN MEADOW DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARLAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75040-3983",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2334 W BUCKINGHAM RD",
"SecondLinePracticeLocationAddress": "SUITE 260",
"PracticeLocationAddressCityName": "GARLAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75042-4934",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-288-9301",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/12/2017",
"LastUpdateDate": "04/12/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "PHONG",
"AuthorizedOfficialMiddleName": "LAN",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "469-288-9301",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "25494",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}