{
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"OrgName": "JEFFREY V MOFFETT D.M.D P.A",
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"FirstLineMailingAddress": "13136 VAIL RIDGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERVIEW",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33579-7187",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-677-3331",
"MailingAddressFaxNumber": "813-677-3336",
"FirstLinePracticeLocationAddress": "13136 VAIL RIDGE DR",
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"PracticeLocationAddressCityName": "RIVERVIEW",
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"PracticeLocationAddressTelephoneNumber": "813-677-3331",
"PracticeLocationAddressFaxNumber": "813-677-3336",
"EnumerationDate": "11/14/2008",
"LastUpdateDate": "11/14/2008",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOFFETT",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.M.D",
"AuthorizedOfficialTelephoneNumber": "813-677-3331",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "DN15450",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}