{
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"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "566 E NORTHWEST HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALATINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60074-6355",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-202-0033",
"MailingAddressFaxNumber": "847-202-0033",
"FirstLinePracticeLocationAddress": "566 E NORTHWEST HWY",
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"PracticeLocationAddressCityName": "PALATINE",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-202-0033",
"PracticeLocationAddressFaxNumber": "847-202-0033",
"EnumerationDate": "05/22/2008",
"LastUpdateDate": "03/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOWALSKI",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "847-202-0033",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}