{
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"FirstLineMailingAddress": "3003 TWIN RIVERS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARKADELPHIA",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71923-4219",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-246-2242",
"MailingAddressFaxNumber": "870-246-2495",
"FirstLinePracticeLocationAddress": "3003 TWIN RIVERS DR",
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"PracticeLocationAddressCityName": "ARKADELPHIA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-246-2242",
"PracticeLocationAddressFaxNumber": "870-246-2495",
"EnumerationDate": "11/24/2008",
"LastUpdateDate": "05/10/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FISH",
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"AuthorizedOfficialTitle": "CREDENTIALING COORDINATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "217-540-5699",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "2256",
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"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."
}
}
}
}