{
"Npi": {
"NPI": "1588919989",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GURNEE DENTAL ARTS",
"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": "731 S IL ROUTE 21",
"SecondLineMailingAddress": "SUITE #160",
"MailingAddressCityName": "GURNEE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60031-3813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "224-433-6009",
"MailingAddressFaxNumber": "224-433-6397",
"FirstLinePracticeLocationAddress": "731 S IL ROUTE 21",
"SecondLinePracticeLocationAddress": "SUITE #160",
"PracticeLocationAddressCityName": "GURNEE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60031-3813",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "224-433-6009",
"PracticeLocationAddressFaxNumber": "224-433-6397",
"EnumerationDate": "07/22/2012",
"LastUpdateDate": "07/22/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LORENO",
"AuthorizedOfficialFirstName": "DESIREE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "773-550-5919",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "019-026161",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}