{
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"FirstLineMailingAddress": "3039 W HORIZON RIDGE PKWY",
"SecondLineMailingAddress": "SUITE 100",
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"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89052-4192",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-489-5237",
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"FirstLinePracticeLocationAddress": "3039 W HORIZON RIDGE PKWY",
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"EnumerationDate": "11/10/2016",
"LastUpdateDate": "11/10/2016",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "GAUTAM",
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"AuthorizedOfficialCredential": "DMD, MDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "S3-245C",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}