{
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"FirstLineMailingAddress": "2803 COUNTY ROAD 237",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALVIN",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-840-3303",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9430 FRY RD",
"SecondLinePracticeLocationAddress": "SUITE 800",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/07/2024",
"LastUpdateDate": "10/07/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NELSON",
"AuthorizedOfficialFirstName": "ROBERT",
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"AuthorizedOfficialTitle": "ORTHODONTIST, OWNER",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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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."
}
}
}
}