{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "LEE&VERCELLOTTI DDS LLC",
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "219 N HAMMES AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOLIET",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60435-8114",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-725-7900",
"MailingAddressFaxNumber": "815-725-9526",
"FirstLinePracticeLocationAddress": "219 N HAMMES AVE",
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"PracticeLocationAddressCityName": "JOLIET",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-725-7900",
"PracticeLocationAddressFaxNumber": "815-725-9526",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEE",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "MANAGING PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "815-725-7900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}