{
"Npi": {
"NPI": "1184280620",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOTHAM SMILES",
"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": "13 W 13TH ST APT 7FS",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10011-7936",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-970-4835",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "157 EAST 32ND STREET",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10016",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "347-772-8387",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/09/2019",
"LastUpdateDate": "05/09/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLAIS",
"AuthorizedOfficialFirstName": "LEO",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "347-772-8387",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}