{
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"LastName": null,
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"FirstLineMailingAddress": "6167 N FRESNO ST STE 103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRESNO",
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"MailingAddressPostalCode": "93710-8610",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-945-5673",
"MailingAddressFaxNumber": "559-981-5375",
"FirstLinePracticeLocationAddress": "6167 N FRESNO ST STE 103",
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"PracticeLocationAddressCityName": "FRESNO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-945-5673",
"PracticeLocationAddressFaxNumber": "559-981-5375",
"EnumerationDate": "06/14/2021",
"LastUpdateDate": "08/08/2021",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ISLAM",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}