{
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"FirstLineMailingAddress": "2534 GENESEE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "UTICA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13502-5814",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-724-5141",
"MailingAddressFaxNumber": "315-733-1270",
"FirstLinePracticeLocationAddress": "2534 GENESEE ST",
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"PracticeLocationAddressCityName": "UTICA",
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"PracticeLocationAddressTelephoneNumber": "315-724-5141",
"PracticeLocationAddressFaxNumber": "315-733-1270",
"EnumerationDate": "10/26/2010",
"LastUpdateDate": "05/03/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLAVIN",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "315-724-5141",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}