{
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"FirstLineMailingAddress": "PO BOX 920050",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75392-0050",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-845-8890",
"MailingAddressFaxNumber": "949-474-1495",
"FirstLinePracticeLocationAddress": "65 W. MITCHELL HAMMOCK RD.",
"SecondLinePracticeLocationAddress": "SUITE 1511",
"PracticeLocationAddressCityName": "OVIEDO",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-604-0399",
"PracticeLocationAddressFaxNumber": "407-604-0405",
"EnumerationDate": "02/28/2018",
"LastUpdateDate": "04/13/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AYOUB",
"AuthorizedOfficialFirstName": "MAYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "615-830-5008",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}