{
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"FirstLineMailingAddress": "27035 BIG HORN MOUNTAIN WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YORBA LINDA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92887-4211",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "14232 SCHLEISMAN RD STE 220",
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"PracticeLocationAddressCityName": "EASTVALE",
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"PracticeLocationAddressTelephoneNumber": "909-464-9348",
"PracticeLocationAddressFaxNumber": "909-464-9349",
"EnumerationDate": "04/29/2020",
"LastUpdateDate": "04/29/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANNA",
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"AuthorizedOfficialCredential": "D.D.S.,M.S.INC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}