{
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"ParentOrgLBN": null,
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"OrgName": "DOGWOOD DENTAL LLC",
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"NamePrefix": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "1545 J ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEDFORD",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47421-3839",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "812-279-9767",
"MailingAddressFaxNumber": "812-279-5971",
"FirstLinePracticeLocationAddress": "262 N MAPLE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLEANS",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressTelephoneNumber": "812-279-9767",
"PracticeLocationAddressFaxNumber": "812-279-5971",
"EnumerationDate": "05/18/2020",
"LastUpdateDate": "05/18/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEISS",
"AuthorizedOfficialFirstName": "NICKOLAUS",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "812-279-9767",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}