{
"Npi": {
"NPI": "1033462817",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "OVESON",
"FirstName": "SAMIRA",
"MiddleName": "JAY",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.D.S.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "AKHAVE",
"OtherFirstName": "SAMIRA",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.D.S.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 521781",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALT LAKE CITY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84152-1781",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-828-5315",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1408 S 1100 E STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALT LAKE CITY",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84105-2400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-828-5315",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/18/2012",
"LastUpdateDate": "10/17/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "61893",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "11318168-9921",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "28689",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}