{
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"FirstLineMailingAddress": "28 BRIGHTON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST GRANBY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06026-9423",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-751-2470",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "697 POQUONOCK AVE UNIT 7",
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"PracticeLocationAddressCityName": "WINDSOR",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressTelephoneNumber": "860-219-0933",
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"EnumerationDate": "12/19/2022",
"LastUpdateDate": "12/19/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ST. BERNARD",
"AuthorizedOfficialFirstName": "LISA",
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"AuthorizedOfficialTitle": "MEMBER /OWNER",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}