{
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"FirstLineMailingAddress": "209 S KIRKWOOD RD",
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"MailingAddressCityName": "KIRKWOOD",
"MailingAddressStateName": "MO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-821-1101",
"MailingAddressFaxNumber": "314-821-3631",
"FirstLinePracticeLocationAddress": "209 S KIRKWOOD RD",
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"PracticeLocationAddressCityName": "KIRKWOOD",
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"PracticeLocationAddressFaxNumber": "314-821-3631",
"EnumerationDate": "06/26/2014",
"LastUpdateDate": "06/26/2014",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCROGGINS",
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"AuthorizedOfficialMiddleName": "MICHELLE",
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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": "2012041113",
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}
},
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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."
}
}
}
}