{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "402 S PINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPARTANBURG",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29302-2712",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "864-582-2371",
"MailingAddressFaxNumber": "864-585-1949",
"FirstLinePracticeLocationAddress": "402 S PINE ST",
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"PracticeLocationAddressCityName": "SPARTANBURG",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-582-2371",
"PracticeLocationAddressFaxNumber": "864-585-1949",
"EnumerationDate": "10/20/2015",
"LastUpdateDate": "10/27/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ARNETT JABBOUR",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "ELIZABETH",
"AuthorizedOfficialTitle": "OWNER/DENTIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "864-582-2371",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD0000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}