{
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"FirstLineMailingAddress": "1101 BRYAN AVE",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "TUSTIN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92780-4401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-544-0200",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1101 BRYAN AVE",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/08/2010",
"LastUpdateDate": "03/08/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AZZEH",
"AuthorizedOfficialFirstName": "EZZ",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "714-544-0200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "55883",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}