{
"Npi": {
"NPI": "1255061354",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NOVA TELEDENTISTRY",
"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": "7451 AUBURN BLVD STE C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CITRUS HEIGHTS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95610-2992",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8111 AZTEC WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANTELOPE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95843-4411",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-540-0737",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/13/2022",
"LastUpdateDate": "06/13/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROCCANOVA",
"AuthorizedOfficialFirstName": "ROXANNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-540-0737",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223D0001X",
"TaxonomyName": "Public Health Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}