{
"Npi": {
"NPI": "1346125713",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BROAD STREET DENTAL",
"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": "225 HYLAND TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORANGE",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06477-1105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-691-7926",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1241 S BROAD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WALLINGFORD",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06492-1737",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-626-5745",
"PracticeLocationAddressFaxNumber": "203-626-9213",
"EnumerationDate": "08/06/2025",
"LastUpdateDate": "08/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALI",
"AuthorizedOfficialFirstName": "AYESHA",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "347-691-7926",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}