{
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"FirstLineMailingAddress": "2624 JENKS AVE",
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"MailingAddressCityName": "PANAMA CITY",
"MailingAddressStateName": "FL",
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"FirstLinePracticeLocationAddress": "2624 JENKS AVE",
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"EnumerationDate": "11/17/2010",
"LastUpdateDate": "06/29/2012",
"NPIDeactivationReasonCode": null,
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"AuthorizedOfficialLastName": "CLAUSSEN",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223S0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
"LicenseNumber": "D17080",
"LicenseNumberStateCode": "FL",
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}
},
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}
}
}
}