{
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"FirstLineMailingAddress": "3925 ABBEY LANE",
"SecondLineMailingAddress": "STE 7",
"MailingAddressCityName": "ASTORIA",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97103-2235",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-836-7711",
"MailingAddressFaxNumber": "951-888-6684",
"FirstLinePracticeLocationAddress": "3925 ABBEY LANE",
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"PracticeLocationAddressFaxNumber": "951-888-8668",
"EnumerationDate": "01/06/2014",
"LastUpdateDate": "01/06/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BECKNER",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "ARNOLD",
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"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": "LD",
"AuthorizedOfficialTelephoneNumber": "503-440-6540",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Denturist",
"LicenseNumber": "DT-DO-10157767",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}