{
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"FirstLineMailingAddress": "17440 FM 529 RD",
"SecondLineMailingAddress": "SUITE 100",
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"MailingAddressPostalCode": "77095-1167",
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"FirstLinePracticeLocationAddress": "17440 FM 529 RD",
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"EnumerationDate": "10/15/2015",
"LastUpdateDate": "10/15/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BANKS",
"AuthorizedOfficialFirstName": "GLENN",
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"AuthorizedOfficialCredential": "D.D.S.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}