{
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"FirstLineMailingAddress": "4036 RIVER OAKS DR STE B2",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-376-2603",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4036 RIVER OAKS DR STE B2",
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"PracticeLocationAddressCityName": "MYRTLE BEACH",
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"EnumerationDate": "09/29/2026",
"LastUpdateDate": "09/29/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}