{
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"FirstLineMailingAddress": "203 PROFESSIONAL PARK DR",
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"MailingAddressCityName": "GLASGOW",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42141-3486",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "203 PROFESSIONAL PARK DR",
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"EnumerationDate": "04/18/2018",
"LastUpdateDate": "06/16/2018",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GALLOWAY",
"AuthorizedOfficialFirstName": "MADISON",
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"AuthorizedOfficialCredential": "DMD, MSD",
"AuthorizedOfficialTelephoneNumber": "270-590-3407",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "9597",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}