{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "308 N 6TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INDEPENDENCE",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "67301-3129",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "620-331-4499",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "308 N 6TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "INDEPENDENCE",
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"PracticeLocationAddressTelephoneNumber": "620-331-4499",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/01/2021",
"LastUpdateDate": "10/01/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REYNOLDS",
"AuthorizedOfficialFirstName": "JUAN",
"AuthorizedOfficialMiddleName": "CAMILO",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "918-907-1335",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}