{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CHENANGO BRIDGE DENTAL, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 481",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHENANGO BRIDGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13745-0481",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-648-4113",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "528 MAIN ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHENANGO BRIDGE",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-648-4113",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/18/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMANOWSKI",
"AuthorizedOfficialFirstName": "STANLEY",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "607-648-4113",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "042233",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}