{
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"FirstLineMailingAddress": "2525 K ST",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95816-5114",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-442-1882",
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"FirstLinePracticeLocationAddress": "2525 K ST",
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"PracticeLocationAddressFaxNumber": "91-644-2303",
"EnumerationDate": "10/10/2006",
"LastUpdateDate": "11/26/2012",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
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"AuthorizedOfficialTitle": "OFFICE ADMINISTRATOR",
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"AuthorizedOfficialTelephoneNumber": "916-961-0570",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "24465",
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}
},
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}
}
}
}