{
"Npi": {
"NPI": "1164975520",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOSHIRI",
"FirstName": "NIKKI",
"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": "715 PALM BAY RD NE STE 185",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST MELBOURNE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32904-9184",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-332-7375",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "36051 5 MILE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LIVONIA",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48154-1931",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-462-6400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/02/2016",
"LastUpdateDate": "09/05/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "2901600357",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN22188",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}