{
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"FirstLineMailingAddress": "615 E APPLEBY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAYETTEVILLE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72703-3914",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-582-1312",
"MailingAddressFaxNumber": "479-582-1355",
"FirstLinePracticeLocationAddress": "615 E APPLEBY RD",
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"PracticeLocationAddressCityName": "FAYETTEVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-582-1312",
"PracticeLocationAddressFaxNumber": "479-582-1355",
"EnumerationDate": "10/12/2006",
"LastUpdateDate": "08/12/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUCKE",
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"AuthorizedOfficialMiddleName": "F",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "479-582-1312",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "3139",
"LicenseNumberStateCode": "AR",
"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."
}
}
}
}