{
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"FirstLineMailingAddress": "1935 E 19TH ST",
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"MailingAddressCityName": "THE DALLES",
"MailingAddressStateName": "OR",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1935 E 19TH ST",
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"EnumerationDate": "01/09/2013",
"LastUpdateDate": "10/07/2019",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "RENNER",
"AuthorizedOfficialFirstName": "MELLISSA",
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"AuthorizedOfficialTelephoneNumber": "541-667-4145",
"Taxonomies": {
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"TaxonomyName": "Pediatric Dentistry",
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}
},
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}
}
}
}