{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1100 HILLGROVE AVE",
"SecondLineMailingAddress": "SUITE 1&2",
"MailingAddressCityName": "WESTERN SPRINGS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60558",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-246-4333",
"MailingAddressFaxNumber": "708-246-4356",
"FirstLinePracticeLocationAddress": "1100 HILLGROVE AVE",
"SecondLinePracticeLocationAddress": "SUITE 1&2",
"PracticeLocationAddressCityName": "WESTERN SPRINGS",
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"PracticeLocationAddressTelephoneNumber": "708-246-4333",
"PracticeLocationAddressFaxNumber": "708-246-4356",
"EnumerationDate": "02/06/2019",
"LastUpdateDate": "02/06/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SZAFRANSKI",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "708-246-4333",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}