{
"Npi": {
"NPI": "1417819616",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "NEW YORK DENTISTRY SERVICES PLLC",
"ParentOrgTIN": null,
"OrgName": "NEW YORK DENTISTRY SERVICES PLLC",
"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": "1610 54TH AVE N STE 205",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NASHVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37209-1442",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-678-0759",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 BOUNDARY AVE STE 202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MASSAPEQUA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11758-1152",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-798-6786",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/26/2025",
"LastUpdateDate": "11/26/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DASCH",
"AuthorizedOfficialFirstName": "CHARLOTTE",
"AuthorizedOfficialMiddleName": "V",
"AuthorizedOfficialTitle": "SR DIRECTOR OF CREDENTIALING",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "504-638-0303",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}