{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CHRISTIANA CREEK DENTAL CARE",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "301 W BRISTOL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELKHART",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46514-3078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "574-262-4378",
"MailingAddressFaxNumber": "574-266-1481",
"FirstLinePracticeLocationAddress": "301 W BRISTOL ST",
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"PracticeLocationAddressCityName": "ELKHART",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "574-262-4378",
"PracticeLocationAddressFaxNumber": "574-266-1481",
"EnumerationDate": "02/28/2007",
"LastUpdateDate": "02/06/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHILL",
"AuthorizedOfficialFirstName": "GAVIN",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "574-262-4378",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "12011190A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}