{
"Npi": {
"NPI": "1356515175",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIDWEST DENTAL ASSOCIATES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1677 MONTGOMERY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AURORA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60504-8802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-499-9400",
"MailingAddressFaxNumber": "630-499-9494",
"FirstLinePracticeLocationAddress": "1677 MONTGOMERY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AURORA",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60504-8802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-499-9400",
"PracticeLocationAddressFaxNumber": "630-499-9494",
"EnumerationDate": "04/14/2008",
"LastUpdateDate": "04/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SALAMAH/ SAMY",
"AuthorizedOfficialFirstName": "MOHAMMED/ SAMAAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "630-499-9400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "019026586",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}