{
"Npi": {
"NPI": "1013433341",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILILANI DENTAL INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "95-1249 MEHEULA PKWY STE 138",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILILANI",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96789-1788",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-625-6223",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "95-1249 MEHEULA PARKWAY",
"SecondLinePracticeLocationAddress": "138",
"PracticeLocationAddressCityName": "MILILANI",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96789",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-625-6223",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/18/2017",
"LastUpdateDate": "06/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATIASEVICH",
"AuthorizedOfficialFirstName": "BRADFORD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "808-366-1097",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "2481",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}