{
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"FirstLineMailingAddress": "9789 MARKET GREEN PL S STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "TN",
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"FirstLinePracticeLocationAddress": "9789 MARKET GREEN PL S STE 101",
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"PracticeLocationAddressCityName": "LAKELAND",
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"PracticeLocationAddressTelephoneNumber": "901-610-1577",
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"EnumerationDate": "07/20/2026",
"LastUpdateDate": "07/20/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAGEN",
"AuthorizedOfficialFirstName": "RYAN",
"AuthorizedOfficialMiddleName": "KEITH",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "901-550-8728",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}