{
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"OrgName": "BLAND MINISTRY CENTER AND DENTAL CLINIC",
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"FirstLineMailingAddress": "65 SEDDON STREET",
"SecondLineMailingAddress": "PO BOX 211",
"MailingAddressCityName": "BLAND",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24315",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-688-4701",
"MailingAddressFaxNumber": "276-688-4700",
"FirstLinePracticeLocationAddress": "435 W NORTH ST",
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"PracticeLocationAddressCityName": "WYTHEVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24382-2246",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-228-4711",
"PracticeLocationAddressFaxNumber": "276-228-4712",
"EnumerationDate": "12/27/2019",
"LastUpdateDate": "12/27/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARRIS-WILKINS",
"AuthorizedOfficialFirstName": "TONYA",
"AuthorizedOfficialMiddleName": "ADRENA",
"AuthorizedOfficialTitle": "DENTAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "276-228-4711",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}