{
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"FirstLineMailingAddress": "PO BOX 167",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MER ROUGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71261-0167",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-647-3960",
"MailingAddressFaxNumber": "318-647-3960",
"FirstLinePracticeLocationAddress": "103 SOUTH 20TH STREET",
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"PracticeLocationAddressCityName": "MER ROUGE",
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"EnumerationDate": "08/27/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OGDEN",
"AuthorizedOfficialFirstName": "SAMUEL",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}