{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MAULIK SHAH DENTAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4116 DRAGOO PARK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95356-1860",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-247-3307",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4120 DALE RD",
"SecondLinePracticeLocationAddress": "SUITE J-6",
"PracticeLocationAddressCityName": "MODESTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95356-9232",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-247-3307",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/06/2009",
"LastUpdateDate": "07/06/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAH",
"AuthorizedOfficialFirstName": "MAULIK",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER DENTIST/CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "209-247-3307",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "50677",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}