{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "TRINITY DENTAL CARE, LLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "14300 GALLANT FOX LN",
"SecondLineMailingAddress": "SUITE 111",
"MailingAddressCityName": "BOWIE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20715-4003",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-262-2929",
"MailingAddressFaxNumber": "301-262-3939",
"FirstLinePracticeLocationAddress": "14300 GALLANT FOX LN",
"SecondLinePracticeLocationAddress": "SUITE 111",
"PracticeLocationAddressCityName": "BOWIE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20715-4003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-262-2929",
"PracticeLocationAddressFaxNumber": "301-262-3939",
"EnumerationDate": "05/26/2016",
"LastUpdateDate": "05/26/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WIREDU",
"AuthorizedOfficialFirstName": "ANGELA",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "301-262-2929",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "11609",
"LicenseNumberStateCode": "MD",
"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."
}
}
}
}