{
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"FirstLineMailingAddress": "3221 84TH AVE. SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERCER ISLAND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98040",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-230-4244",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3900 EAST VALLEY RD. SUITE 203",
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"PracticeLocationAddressCityName": "RENTON",
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"PracticeLocationAddressTelephoneNumber": "425-264-0044",
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"EnumerationDate": "07/16/2010",
"LastUpdateDate": "07/16/2010",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAIGE",
"AuthorizedOfficialFirstName": "STEVEN",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DE00007186",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}