{
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"FirstLineMailingAddress": "575 BOYLSTON ST FL 7",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOSTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02116-3607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-267-3889",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "575 BOYLSTON ST FL 7",
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"PracticeLocationAddressCityName": "BOSTON",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2015",
"LastUpdateDate": "06/23/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GHEDDAF DAM",
"AuthorizedOfficialFirstName": "HAMASAT",
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"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DMD, DR.MED.DENT",
"AuthorizedOfficialTelephoneNumber": "617-267-3889",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN1856379",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}