{
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"FirstLineMailingAddress": "820 N SUPERIOR AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOMAH",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54660-1120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "608-372-5000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "820 N SUPERIOR AVE",
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"EnumerationDate": "09/28/2009",
"LastUpdateDate": "03/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KONZE",
"AuthorizedOfficialFirstName": "KATHERINE",
"AuthorizedOfficialMiddleName": "E",
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"AuthorizedOfficialCredential": "PHR",
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"Taxonomies": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "3857",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}