{
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"FirstLineMailingAddress": "700 W 19TH ST.",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "COSTA MESA",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"EnumerationDate": "06/21/2017",
"LastUpdateDate": "06/21/2017",
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"AuthorizedOfficialLastName": "MEJIA",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "DDS100192",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}