{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MARK LEVY DDS INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "1335 DUBLIN RD STE 100B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBUS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43215-1000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-777-7350",
"MailingAddressFaxNumber": "888-390-0424",
"FirstLinePracticeLocationAddress": "1335 DUBLIN RD STE 100B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "OH",
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"PracticeLocationAddressTelephoneNumber": "614-777-7350",
"PracticeLocationAddressFaxNumber": "888-390-0424",
"EnumerationDate": "04/27/2014",
"LastUpdateDate": "11/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEVY",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "614-777-7350",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "16150",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BC3200X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}