{
"Npi": {
"NPI": "1396071577",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ISIOMA A. OKONMAH D.D.S., M.P.H., P.A.",
"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": "408 STATESVILLE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALISBURY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28144-2318",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-637-2120",
"MailingAddressFaxNumber": "704-637-1283",
"FirstLinePracticeLocationAddress": "408 STATESVILLE BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALISBURY",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28144-2318",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-637-2120",
"PracticeLocationAddressFaxNumber": "704-637-1283",
"EnumerationDate": "10/23/2009",
"LastUpdateDate": "10/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OKONMAH",
"AuthorizedOfficialFirstName": "ISIOMA",
"AuthorizedOfficialMiddleName": "ANTHONIA",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S., M.P.H.",
"AuthorizedOfficialTelephoneNumber": "908-906-8172",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "7842",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}