{
"Npi": {
"NPI": "1235259862",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NIHON SHIKA GROUP",
"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": "1212 E PUTNAM AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06878-1431",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-637-1115",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1212 E PUTNAM AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERSIDE",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06878-1431",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-637-1115",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/29/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BELOK",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.,M.P.H.",
"AuthorizedOfficialTelephoneNumber": "201-461-0618",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "4494",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}