{
"Npi": {
"NPI": "1679958052",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QUEENSVILLAGEDENTALCARE,P.C.",
"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": "22005 94TH DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "QUEENS VILLAGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11428-2105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-465-3265",
"MailingAddressFaxNumber": "718-776-4260",
"FirstLinePracticeLocationAddress": "22005 94TH DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "QUEENS VILLAGE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11428-2105",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-465-3265",
"PracticeLocationAddressFaxNumber": "718-776-4260",
"EnumerationDate": "07/27/2015",
"LastUpdateDate": "07/27/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAHASE",
"AuthorizedOfficialFirstName": "TERENCE",
"AuthorizedOfficialMiddleName": "TEEKAH",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S",
"AuthorizedOfficialTelephoneNumber": "718-465-3265",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "042201",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}