{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PINES FAMILY DENTAL",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20170 PINES BLVD STE 108",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEMBROKE PINES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33029-1202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-430-1717",
"MailingAddressFaxNumber": "954-430-3049",
"FirstLinePracticeLocationAddress": "20170 PINES BLVD STE 108",
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"PracticeLocationAddressCityName": "PEMBROKE PINES",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-430-1717",
"PracticeLocationAddressFaxNumber": "954-430-3049",
"EnumerationDate": "01/22/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIZASO",
"AuthorizedOfficialFirstName": "RAUL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "954-430-1717",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DN001496",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}