{
"Npi": {
"NPI": "1891050894",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BORDA",
"FirstName": "ALISSA",
"MiddleName": "FORD",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD, MPH, MS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3236 78TH AVE SE STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERCER ISLAND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98040-3500",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-707-7650",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3236 78TH AVE SE STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MERCER ISLAND",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98040-3500",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-707-7650",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/06/2012",
"LastUpdateDate": "01/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "DE60381759",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}