{
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"FirstLineMailingAddress": "1406 KINGSLEY AVE",
"SecondLineMailingAddress": "STE B",
"MailingAddressCityName": "ORANGE PARK",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-264-4519",
"MailingAddressFaxNumber": "904-264-4510",
"FirstLinePracticeLocationAddress": "1406 KINGSLEY AVE",
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"PracticeLocationAddressFaxNumber": "904-264-4510",
"EnumerationDate": "07/13/2015",
"LastUpdateDate": "07/13/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "HOFFMAN",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.M.D., M.S.",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "20979",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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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."
}
}
}
}