{
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"FirstLineMailingAddress": "2160 W GRANT LINE RD STE 245",
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"MailingAddressFaxNumber": "209-834-0582",
"FirstLinePracticeLocationAddress": "2160 W GRANT LINE RD STE 245",
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"PracticeLocationAddressFaxNumber": "209-834-0582",
"EnumerationDate": "03/13/2007",
"LastUpdateDate": "05/07/2018",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
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"AuthorizedOfficialTelephoneNumber": "209-574-9600",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}