{
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"FirstName": null,
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"FirstLineMailingAddress": "PO BOX 127",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREEN RIVER",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82935-0127",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-875-7770",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "220 SHOSHONE AVE",
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"PracticeLocationAddressCityName": "GREEN RIVER",
"PracticeLocationAddressStateName": "WY",
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"PracticeLocationAddressTelephoneNumber": "307-875-7770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/18/2014",
"LastUpdateDate": "01/26/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANNER",
"AuthorizedOfficialFirstName": "DEVIN",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "208-716-4382",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "1382",
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"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."
}
}
}
}