{
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"FirstLineMailingAddress": "3302 SOUTH GROVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BERWYN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60402",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-788-8200",
"MailingAddressFaxNumber": "708-795-8997",
"FirstLinePracticeLocationAddress": "3302 SOUTH GROVE",
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"PracticeLocationAddressCityName": "BERWYN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-788-8200",
"PracticeLocationAddressFaxNumber": "708-795-8997",
"EnumerationDate": "01/19/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARCHMONT-ROBINSON",
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}