{
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"FirstLineMailingAddress": "1037 US HIGHWAY 46",
"SecondLineMailingAddress": "CG-1",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "973-473-2017",
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"PracticeLocationAddressFaxNumber": "973-473-2017",
"EnumerationDate": "08/05/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RALPH",
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"AuthorizedOfficialCredential": "D.M.D.",
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}