{
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"FirstLineMailingAddress": "1421 WAYZATA BLVD",
"SecondLineMailingAddress": "SUITE #325",
"MailingAddressCityName": "WAYZATA",
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"MailingAddressPostalCode": "55391-1939",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-476-6655",
"MailingAddressFaxNumber": "952-476-8293",
"FirstLinePracticeLocationAddress": "1421 WAYZATA BLVD",
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"PracticeLocationAddressTelephoneNumber": "952-476-6655",
"PracticeLocationAddressFaxNumber": "952-476-8293",
"EnumerationDate": "08/21/2006",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOUERS",
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"AuthorizedOfficialCredential": "DDS",
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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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}
}
}
}