{
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"ParentOrgLBN": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "772 S FRONT ST APT 100B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "484-744-3403",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2416 W DARBY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAVERTOWN",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressTelephoneNumber": "610-446-4210",
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"EnumerationDate": "09/29/2021",
"LastUpdateDate": "09/29/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REILLY",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}