{
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"EIN": null,
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"OrgName": "FREDERICK P WALDSCHMIDT D D S P C",
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"NamePrefix": null,
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"FirstLineMailingAddress": "750 ALMAR PARKWAY",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "BOURBONNAIS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60914",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-932-5221",
"MailingAddressFaxNumber": "815-932-5269",
"FirstLinePracticeLocationAddress": "750 ALMAR PARKWAY",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "BOURBONNAIS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-932-5221",
"PracticeLocationAddressFaxNumber": "815-932-5269",
"EnumerationDate": "11/17/2006",
"LastUpdateDate": "04/21/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALDSCHMIDT",
"AuthorizedOfficialFirstName": "FREDERICK",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "PRESIDENT SECRETARY TREASURER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "815-932-5221",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "019019355",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}