{
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"FirstLineMailingAddress": "23700 ORCHARD LAKE RD STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON HILLS",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-474-5572",
"MailingAddressFaxNumber": "248-474-3039",
"FirstLinePracticeLocationAddress": "23700 ORCHARD LAKE RD STE A",
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"PracticeLocationAddressCityName": "FARMINGTON HILLS",
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"PracticeLocationAddressFaxNumber": "248-474-3039",
"EnumerationDate": "09/11/2008",
"LastUpdateDate": "06/08/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRANHAM",
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"AuthorizedOfficialCredential": "D.D.S.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "2901019601",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}