{
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"OrgName": "RIVERWALK FAMILY DENTISTRY",
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"FirstLineMailingAddress": "PO BOX 915912",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONGWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32791-5912",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2199 E SEMORAN BLVD",
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"PracticeLocationAddressCityName": "APOPKA",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/21/2007",
"LastUpdateDate": "12/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIDSON",
"AuthorizedOfficialFirstName": "SUZANNE",
"AuthorizedOfficialMiddleName": "NICOLA",
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"AuthorizedOfficialCredential": "D.M.D",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "0012300",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}