{
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"FirstLineMailingAddress": "PO BOX 2222",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LILLINGTON",
"MailingAddressStateName": "NC",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-893-1096",
"MailingAddressFaxNumber": "910-814-1559",
"FirstLinePracticeLocationAddress": "5923 W FRIENDLY AVE",
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"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressTelephoneNumber": "336-632-0744",
"PracticeLocationAddressFaxNumber": "336-632-0754",
"EnumerationDate": "09/09/2008",
"LastUpdateDate": "09/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "8689",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}