{
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"FirstLineMailingAddress": "1194 W ASH ST STE E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINDSOR",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80550-4608",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-686-6899",
"MailingAddressFaxNumber": "970-686-0889",
"FirstLinePracticeLocationAddress": "1194 W ASH ST STE E",
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"PracticeLocationAddressCityName": "WINDSOR",
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"PracticeLocationAddressFaxNumber": "970-686-0889",
"EnumerationDate": "03/02/2009",
"LastUpdateDate": "03/02/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAHL",
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"AuthorizedOfficialCredential": "RDH, RMT, CCP",
"AuthorizedOfficialTelephoneNumber": "970-686-6899",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "124Q00000X",
"TaxonomyName": "Dental Hygienist",
"LicenseNumber": "1848",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}