{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MEADOWS DENTAL GROUP",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4949 EUCLID AVE",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "PALATINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60067-7212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-397-1111",
"MailingAddressFaxNumber": "847-397-1142",
"FirstLinePracticeLocationAddress": "4949 EUCLID AVE",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "PALATINE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60067-7212",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-397-1111",
"PracticeLocationAddressFaxNumber": "847-397-1142",
"EnumerationDate": "04/11/2006",
"LastUpdateDate": "09/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RADIN",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "SAMUEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S, MAS",
"AuthorizedOfficialTelephoneNumber": "847-397-1111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "19A16023",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}