{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "QUEENSBORO DENTAL PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15034 UNION TPKE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLUSHING",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11367-3928",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-380-0011",
"MailingAddressFaxNumber": "718-820-0841",
"FirstLinePracticeLocationAddress": "15034 UNION TPKE",
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"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "718-380-0011",
"PracticeLocationAddressFaxNumber": "718-820-0841",
"EnumerationDate": "04/09/2008",
"LastUpdateDate": "04/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "M",
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"AuthorizedOfficialTitle": "OFFICE MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-380-0011",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "045477",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}