{
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"FirstLineMailingAddress": "1516 MADISON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MAYWOOD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60153-1824",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1516 MADISON ST",
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"PracticeLocationAddressCityName": "MAYWOOD",
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"EnumerationDate": "04/08/2008",
"LastUpdateDate": "04/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOKARSKI",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": "ROBERT",
"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}