{
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"OrgName": "DAVIDSON- TUCKER ORAL SURGERY ASSOCIATES",
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"FirstLineMailingAddress": "17 ARENTZEN BLVD",
"SecondLineMailingAddress": "SUITE #104",
"MailingAddressCityName": "CHARLEROI",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15022-1085",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-483-5080",
"MailingAddressFaxNumber": "724-483-3760",
"FirstLinePracticeLocationAddress": "17 ARENTZEN BLVD",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "724-483-3760",
"EnumerationDate": "07/02/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TUCKER",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "PETER",
"AuthorizedOfficialTitle": "PRESIDENT, DAVIDSON-TUCKER ORAL SUR",
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"AuthorizedOfficialCredential": "D.M.D.",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
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}
},
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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."
}
}
}
}