{
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"OrgName": "GHIAS JABBOUR D.D.S ,PLLC",
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"FirstLineMailingAddress": "19179 BLANCO RD STE 106",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78258-4043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-800-2539",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19179 BLANCO RD STE 106",
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"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressTelephoneNumber": "909-800-2539",
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"EnumerationDate": "05/11/2012",
"LastUpdateDate": "05/11/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JABBOUR",
"AuthorizedOfficialFirstName": "GHIAS",
"AuthorizedOfficialMiddleName": "KAISAR",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "909-800-2539",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "23094",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}