{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUDBURY DENTAL ASSOCIATES",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "25 TRUMAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWTON CENTER",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02459-2638",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "410 BOSTON POST RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUDBURY",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01776-3058",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-686-8254",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/10/2023",
"LastUpdateDate": "07/10/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOU",
"AuthorizedOfficialFirstName": "YALI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "617-686-8254",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}