{
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"FirstLineMailingAddress": "1501 ALEXANDER ST SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49506-3384",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-980-6539",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1501 ALEXANDER ST SE",
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"PracticeLocationAddressCityName": "GRAND RAPIDS",
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"PracticeLocationAddressTelephoneNumber": "989-980-6539",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/08/2021",
"LastUpdateDate": "08/06/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEMMER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "989-980-6539",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}