{
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"OrgName": "GREGORY GOGGANS, D.M.D., P.C.",
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"FirstLineMailingAddress": "PO BOX 674474",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75267-4474",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "6420 HIGHWAY 11 N STE C",
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"PracticeLocationAddressCityName": "CARRIERE",
"PracticeLocationAddressStateName": "MS",
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"PracticeLocationAddressTelephoneNumber": "601-799-3120",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/07/2018",
"LastUpdateDate": "05/04/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOGGANS",
"AuthorizedOfficialFirstName": "GREGORY",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DMD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "3983-18",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}