{
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"FirstLineMailingAddress": "16683 WASHINGTON ST BLDG 5",
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"MailingAddressCityName": "THORNTON",
"MailingAddressStateName": "CO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-450-3165",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "16683 WASHINGTON ST BLDG 5",
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"PracticeLocationAddressCityName": "THORNTON",
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"PracticeLocationAddressTelephoneNumber": "303-450-3165",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/19/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CETTIE",
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"AuthorizedOfficialTelephoneNumber": "832-470-6344",
"Taxonomies": {
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"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "00202110",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}