{
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"FirstLineMailingAddress": "57 WEST 57TH STREET",
"SecondLineMailingAddress": "SUITE 1207",
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"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "57 WEST 57 STREET",
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"EnumerationDate": "04/30/2008",
"LastUpdateDate": "04/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SKINNER",
"AuthorizedOfficialFirstName": "GREGORY",
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"AuthorizedOfficialCredential": "D.D.S.",
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"Taxonomies": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "046610",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}