{
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"OrgName": "SMILEBRITE LLC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "401 WALL ST",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "VALPARAISO",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46383-2521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "219-286-6228",
"MailingAddressFaxNumber": "219-286-6229",
"FirstLinePracticeLocationAddress": "401 WALL ST",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "VALPARAISO",
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"PracticeLocationAddressTelephoneNumber": "219-286-6228",
"PracticeLocationAddressFaxNumber": "219-286-6229",
"EnumerationDate": "10/21/2016",
"LastUpdateDate": "10/21/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DELUMPA FOLKE",
"AuthorizedOfficialFirstName": "BERNADETTE",
"AuthorizedOfficialMiddleName": "ANNE",
"AuthorizedOfficialTitle": "SOLE OWNER/PEDIATRIC DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S., M.S.",
"AuthorizedOfficialTelephoneNumber": "219-395-0403",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "12009505",
"LicenseNumberStateCode": "IN",
"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."
}
}
}
}