{
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"FirstLineMailingAddress": "824 ALLEN ST",
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"MailingAddressCityName": "BOONE",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50036-2709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-541-7741",
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"FirstLinePracticeLocationAddress": "1620 S KELLOGG AVE STE 107",
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"PracticeLocationAddressCityName": "AMES",
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"PracticeLocationAddressTelephoneNumber": "515-233-3303",
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"EnumerationDate": "06/12/2026",
"LastUpdateDate": "06/12/2026",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENSEN",
"AuthorizedOfficialFirstName": "SHANNON",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}