{
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"EIN": null,
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"OrgName": "ADVANCED DENTAL CARE OF CHESTERFIELD INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2827 ARIZONA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOPLIN",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64804",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-782-5005",
"MailingAddressFaxNumber": "417-782-0175",
"FirstLinePracticeLocationAddress": "2104 W CHESTERFIELD BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65804",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-889-5015",
"PracticeLocationAddressFaxNumber": "417-889-5016",
"EnumerationDate": "09/08/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DURLING",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "417-782-4295",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "2000144128",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}