{
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"FirstLineMailingAddress": "2000 MAPLE ST STE 100",
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"MailingAddressStateName": "MT",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2000 MAPLE ST STE 100",
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"EnumerationDate": "07/27/2022",
"LastUpdateDate": "12/23/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARIA",
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"Taxonomies": {
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"TaxonomyName": "Dental Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}