{
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"FirstLineMailingAddress": "815 N GALENA AVE",
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"MailingAddressStateName": "IL",
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"FirstLinePracticeLocationAddress": "815 N GALENA AVE",
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"EnumerationDate": "07/17/2006",
"LastUpdateDate": "10/22/2012",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "LESAGE",
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"Taxonomies": {
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"TaxonomyName": "General Practice Dentistry",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}