{
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"FirstLineMailingAddress": "546 S BROAD ST",
"SecondLineMailingAddress": "SUITE 2D",
"MailingAddressCityName": "MERIDEN",
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"MailingAddressPostalCode": "06450-6600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-886-0028",
"MailingAddressFaxNumber": "203-886-0035",
"FirstLinePracticeLocationAddress": "546 S BROAD ST",
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"PracticeLocationAddressFaxNumber": "203-886-0035",
"EnumerationDate": "03/08/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOX",
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"AuthorizedOfficialMiddleName": "NILES",
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"AuthorizedOfficialCredential": "D.M.D.",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
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"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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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."
}
}
}
}