{
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"FirstLineMailingAddress": "650 W BALTIMORE ST",
"SecondLineMailingAddress": "ROOM 5201",
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"MailingAddressPostalCode": "21201-1510",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-706-7625",
"MailingAddressFaxNumber": "410-706-3028",
"FirstLinePracticeLocationAddress": "650 W BALTIMORE ST",
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"PracticeLocationAddressFaxNumber": "410-706-3028",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "11/27/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEILLER",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "FRANCIS",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
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"TaxonomyName": "Dentist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}