{
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"FirstLineMailingAddress": "PO BOX 70887",
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"MailingAddressStateName": "OH",
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"FirstLinePracticeLocationAddress": "6421 WEST RD",
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"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
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"EnumerationDate": "07/28/2023",
"LastUpdateDate": "09/14/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "JACOMINO-BARNES",
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"AuthorizedOfficialTelephoneNumber": "813-270-9497",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}