{
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"EIN": null,
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"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1253 SCALP AVE STE 105",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNSTOWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15904-3137",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-266-1070",
"MailingAddressFaxNumber": "814-266-5881",
"FirstLinePracticeLocationAddress": "213 PARKS RD",
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"PracticeLocationAddressCityName": "CHESTER",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-739-4665",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/01/2018",
"LastUpdateDate": "06/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POLLINA",
"AuthorizedOfficialFirstName": "SAMUAL",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "410-739-4465",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "15932",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}