{
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"LastName": null,
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"FirstLineMailingAddress": "347 CENTRAL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAUGUS",
"MailingAddressStateName": "MA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-233-1189",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "40 TREMONT ST STE 58",
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"PracticeLocationAddressCityName": "DUXBURY",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2020",
"LastUpdateDate": "01/24/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LHO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "781-233-1189",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}