{
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"OrgName": "KELLEY L. BORDERS, D.M.D., P.A.",
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"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1708 S ALEXANDER ST",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "PLANT CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33563-8411",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1708 S ALEXANDER ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "PLANT CITY",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-752-5600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/02/2014",
"LastUpdateDate": "07/02/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BORDERS",
"AuthorizedOfficialFirstName": "KELLEY",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "PRESIDENT DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "813-334-3798",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "DN16284",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}