{
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"EIN": null,
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"OrgName": "BUENA DENTAL GROUP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"FirstLineMailingAddress": "PO BOX 312",
"SecondLineMailingAddress": "STE. 40",
"MailingAddressCityName": "OXNARD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93032-0312",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-382-8000",
"MailingAddressFaxNumber": "805-382-8002",
"FirstLinePracticeLocationAddress": "421 S VENTURA RD",
"SecondLinePracticeLocationAddress": "STE. 40",
"PracticeLocationAddressCityName": "OXNARD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93030-6551",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-382-8000",
"PracticeLocationAddressFaxNumber": "805-382-8002",
"EnumerationDate": "01/04/2012",
"LastUpdateDate": "01/04/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FUJIMURA",
"AuthorizedOfficialFirstName": "GUILLERMO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST /PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "805-382-8000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "38283",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}