{
"Npi": {
"NPI": "1659811065",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WORMSER SMILES DENTAL OFFICE INC",
"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": "910 VIA DE LA PAZ",
"SecondLineMailingAddress": "108",
"MailingAddressCityName": "PACIFIC PALISADES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90272-3515",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-454-3732",
"MailingAddressFaxNumber": "310-459-2245",
"FirstLinePracticeLocationAddress": "910 VIA DE LA PAZ",
"SecondLinePracticeLocationAddress": "SUITE 108",
"PracticeLocationAddressCityName": "PACIFIC PALISADES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90272-3515",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-454-3732",
"PracticeLocationAddressFaxNumber": "310-459-2245",
"EnumerationDate": "03/03/2017",
"LastUpdateDate": "03/03/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WORMSER",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "PHILIP",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "310-454-3732",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "28832",
"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."
}
}
}
}