{
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"FirstLineMailingAddress": "2772 JOHNSON DR",
"SecondLineMailingAddress": "SUITE 101",
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"FirstLinePracticeLocationAddress": "2772 JOHNSON DR",
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"PracticeLocationAddressFaxNumber": "805-658-7049",
"EnumerationDate": "01/30/2006",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "COOPER",
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"AuthorizedOfficialMiddleName": "W.",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
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{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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},
{
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}
]
}
}
}