{
"Npi": {
"NPI": "1063105575",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BADER",
"FirstName": "MOHAMMAD",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BADER",
"OtherFirstName": "MOHAMMAD",
"OtherMiddleName": "I",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DMD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "333 E ONTARIO ST APT 4403",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60611-4895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-387-0377",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4849 W BELMONT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60641-4330",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-735-8353",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/31/2023",
"LastUpdateDate": "05/31/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "019034278",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}