{
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"FirstLineMailingAddress": "248 E 800 N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHFIELD",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84701-1916",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-227-6611",
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"FirstLinePracticeLocationAddress": "4400 BAYOU BLVD STE 44A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PENSACOLA",
"PracticeLocationAddressStateName": "FL",
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"EnumerationDate": "06/13/2023",
"LastUpdateDate": "06/13/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LINDSAY",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}