{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ENHANCE DENTAL- TROLLEY PLACE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "530 E 500 S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALT LAKE CITY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84102-2707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-747-8015",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "530 E 500 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALT LAKE CITY",
"PracticeLocationAddressStateName": "UT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-747-8015",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/15/2021",
"LastUpdateDate": "06/15/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOWMAN",
"AuthorizedOfficialFirstName": "BENJAMIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "405-326-8004",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}