{
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"EIN": null,
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"OrgName": "TIMOTHY O. HART DDS MS, LTD",
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"FirstLineMailingAddress": "1720 E LAKE BLUFF BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHOREWOOD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53211-1517",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-962-1800",
"MailingAddressFaxNumber": "414-962-2302",
"FirstLinePracticeLocationAddress": "1720 E LAKE BLUFF BLVD",
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"PracticeLocationAddressCityName": "SHOREWOOD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-962-1800",
"PracticeLocationAddressFaxNumber": "414-962-2302",
"EnumerationDate": "01/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HART",
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"AuthorizedOfficialMiddleName": "OTTO",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "414-962-1800",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Prosthodontics",
"LicenseNumber": "1896G",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}