{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERRY ALLEN DDS PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "4413 VALLEY FORGE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DURHAM",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27705-6425",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-221-5644",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "245 E NC HIGHWAY 54 STE 204",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DURHAM",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27713-2552",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-221-5644",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/24/2026",
"LastUpdateDate": "04/24/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "JERRY",
"AuthorizedOfficialMiddleName": "ARTHUR",
"AuthorizedOfficialTitle": "OWNER DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "919-221-5644",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}