{
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"FirstLineMailingAddress": "75 CONANT RD",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-351-1355",
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"FirstLinePracticeLocationAddress": "66 SOUTH ST",
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"PracticeLocationAddressCityName": "WALTHAM",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "10/06/2026",
"LastUpdateDate": "10/06/2026",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REILLY",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
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}
},
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}
}