{
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"FirstLineMailingAddress": "219 E 12300 S",
"SecondLineMailingAddress": "SUITE I-5",
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"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84020-6970",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-789-7669",
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"FirstLinePracticeLocationAddress": "1308 E. EAGLE MOUNTAIN BLVD",
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"PracticeLocationAddressCityName": "EAGLE MOUNTAIN",
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"PracticeLocationAddressTelephoneNumber": "801-876-7669",
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"EnumerationDate": "02/14/2017",
"LastUpdateDate": "03/16/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TORNOW",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "505-947-4252",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dental Clinic/Center",
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"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}