{
"Npi": {
"NPI": "1487103354",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DROZDZ DENTAL SERVICES, INC.",
"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": "4529 S SEMINOLE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLENVIEW",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60026-7303",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "224-628-4008",
"MailingAddressFaxNumber": "224-213-7453",
"FirstLinePracticeLocationAddress": "3633 W LAKE AVE",
"SecondLinePracticeLocationAddress": "SUITE 409",
"PracticeLocationAddressCityName": "GLENVIEW",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60026-5805",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "224-628-4008",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/03/2016",
"LastUpdateDate": "10/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DROZDZ",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "MITCHELL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "224-628-4008",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "019-018712",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}