{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BONNESS FAMILY DENTISTRY PC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "10701 ALLIANCE DR",
"SecondLineMailingAddress": "SUITE F",
"MailingAddressCityName": "CAMBY",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46113-8836",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-821-1130",
"MailingAddressFaxNumber": "317-821-1145",
"FirstLinePracticeLocationAddress": "10701 ALLIANCE DR",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "CAMBY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-821-1130",
"PracticeLocationAddressFaxNumber": "317-821-1145",
"EnumerationDate": "06/20/2008",
"LastUpdateDate": "06/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BONNESS",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "AARON",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "317-821-1130",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "12010300A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}