{
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"FirstLineMailingAddress": "10442 PATTERSON AVE",
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"MailingAddressCityName": "HENRICO",
"MailingAddressStateName": "VA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "804-741-8696",
"FirstLinePracticeLocationAddress": "10442 PATTERSON AVE",
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"PracticeLocationAddressFaxNumber": "804-741-8696",
"EnumerationDate": "08/02/2016",
"LastUpdateDate": "08/02/2016",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "MCANDREW",
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"AuthorizedOfficialCredential": "DMD, MS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0700X",
"TaxonomyName": "Prosthodontics",
"LicenseNumber": "0401008709",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}