{
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"EIN": null,
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"OtherCredential": "D.M.D., P.A.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "2327 BLACK LAKE BLVD.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER GARDEN",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "8810 S.W. STATE ROAD 200",
"SecondLinePracticeLocationAddress": "SUITE 101",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-854-7070",
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"EnumerationDate": "03/06/2007",
"LastUpdateDate": "07/08/2007",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}