{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "STOBBE EGGETT DENTAL",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "394 S MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOOELE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84074-2746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-882-2331",
"MailingAddressFaxNumber": "435-882-2334",
"FirstLinePracticeLocationAddress": "394 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOOELE",
"PracticeLocationAddressStateName": "UT",
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"PracticeLocationAddressTelephoneNumber": "435-882-2331",
"PracticeLocationAddressFaxNumber": "435-882-2334",
"EnumerationDate": "05/11/2017",
"LastUpdateDate": "05/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COX",
"AuthorizedOfficialFirstName": "KATHY",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "435-882-2331",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "4923271",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}