{
"Npi": {
"NPI": "1356733869",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NWANDO UDOM DDS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2 KERRYANN CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONROE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08831-5156",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-377-9120",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "84 VERONICA AVE",
"SecondLinePracticeLocationAddress": "SUITE B1017",
"PracticeLocationAddressCityName": "SOMERSET",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08873-3529",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-210-0505",
"PracticeLocationAddressFaxNumber": "732-210-0506",
"EnumerationDate": "02/21/2015",
"LastUpdateDate": "02/21/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UDOM",
"AuthorizedOfficialFirstName": "NWANDO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "GENERAL DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "732-210-0505",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "22DI02360900",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}