{
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"FirstLineMailingAddress": "8351 ROCHESTER AVE",
"SecondLineMailingAddress": "STE 109",
"MailingAddressCityName": "RANCHO CUCAMONGA",
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"MailingAddressPostalCode": "91739",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-466-5351",
"MailingAddressFaxNumber": "909-466-5357",
"FirstLinePracticeLocationAddress": "8351 ROCHESTER AVE",
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"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressFaxNumber": "909-466-5357",
"EnumerationDate": "02/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARRAMEDA",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}