{
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"FirstLineMailingAddress": "9144 BROADWAY AVE",
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"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "708-485-6454",
"FirstLinePracticeLocationAddress": "9144 BROADWAY AVE",
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"PracticeLocationAddressFaxNumber": "708-485-6454",
"EnumerationDate": "03/30/2015",
"LastUpdateDate": "03/30/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAUNESCU",
"AuthorizedOfficialFirstName": "TATIANA",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}