{
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"FirstLineMailingAddress": "2411 N HALL ST",
"SecondLineMailingAddress": "UNIT #20",
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75204-2834",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4306 MATLOCK RD",
"SecondLinePracticeLocationAddress": "STE 116",
"PracticeLocationAddressCityName": "ARLINGTON",
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"EnumerationDate": "07/26/2011",
"LastUpdateDate": "05/17/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "IP",
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"AuthorizedOfficialTitle": "GENERAL DENTIST",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "22988",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}