{
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"FirstLineMailingAddress": "PO BOX 490",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLOUCESTER",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23061-0490",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-693-2575",
"MailingAddressFaxNumber": "804-694-5235",
"FirstLinePracticeLocationAddress": "6661 MAIN ST",
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"PracticeLocationAddressCityName": "GLOUCESTER",
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"PracticeLocationAddressFaxNumber": "804-694-5235",
"EnumerationDate": "11/05/2014",
"LastUpdateDate": "11/05/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEIGH",
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"AuthorizedOfficialMiddleName": "ALAN",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "804-693-2575",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0401006547",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}