{
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"FirstLineMailingAddress": "515 KEISLER DR STE 204",
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"FirstLinePracticeLocationAddress": "515 KEISLER DR STE 204",
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"EnumerationDate": "12/31/2025",
"LastUpdateDate": "12/31/2025",
"NPIDeactivationReasonCode": null,
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"GenderCode": null,
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"AuthorizedOfficialLastName": "PASTOOR",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}