{
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"EIN": null,
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"ParentOrgLBN": null,
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"OrgName": "TYLER DENTAL LLC",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2975 PLAZA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUNKIRK",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20754-2735",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-327-5086",
"MailingAddressFaxNumber": "301-327-5088",
"FirstLinePracticeLocationAddress": "2975 PLAZA DR",
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"PracticeLocationAddressCityName": "DUNKIRK",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-327-5086",
"PracticeLocationAddressFaxNumber": "301-327-5088",
"EnumerationDate": "04/05/2011",
"LastUpdateDate": "05/23/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TYLER",
"AuthorizedOfficialFirstName": "JERAL",
"AuthorizedOfficialMiddleName": "S",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "13898",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}