{
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"FirstLineMailingAddress": "850 E. GRAND AVENUE",
"SecondLineMailingAddress": "SUITE A",
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"MailingAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "760-432-8764",
"EnumerationDate": "08/08/2006",
"LastUpdateDate": "01/10/2014",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "HARBERTSON",
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"AuthorizedOfficialCredential": "D.D.S., M.S.",
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"TaxonomyName": "Periodontics",
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}
},
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}
}
}
}