{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "OHIO DENTAL ASSOCIATES--JUDGE INC",
"LastName": null,
"FirstName": null,
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"FirstLineMailingAddress": "PO BOX 3189",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SYRACUSE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13220-3189",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-454-6000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1121 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOWLING GREEN",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43402-4747",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-353-3686",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/11/2013",
"LastUpdateDate": "06/11/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JUDGE",
"AuthorizedOfficialFirstName": "ARWINDER",
"AuthorizedOfficialMiddleName": "SINGH",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "22926",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}