{
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"LastName": null,
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"FirstLineMailingAddress": "2016 N STATE HIGHWAY 121",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BONHAM",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-616-1574",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2016 STATE HIGHWAY 121 N",
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"PracticeLocationAddressCityName": "BONHAM",
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"PracticeLocationAddressTelephoneNumber": "903-227-6576",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/19/2019",
"LastUpdateDate": "09/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GATES",
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"AuthorizedOfficialTitle": "DENTIST",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "405-227-6100",
"Taxonomies": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}