{
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"FirstLineMailingAddress": "120 BEULAH RD NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIENNA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22180-4745",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-938-2000",
"MailingAddressFaxNumber": "703-938-9447",
"FirstLinePracticeLocationAddress": "120 BEULAH RD NE",
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"PracticeLocationAddressCityName": "VIENNA",
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"PracticeLocationAddressFaxNumber": "703-938-9447",
"EnumerationDate": "07/21/2006",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COVEL",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0401007703",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}