{
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"NPI": "1043006588",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SIGNATURE SMILES DENTAL GROUP - BURBANK",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3331 CASTLEMAN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURBANK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91504-1630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-454-6382",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2114 N GLENOAKS BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURBANK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91504-2827",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-846-8915",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/18/2025",
"LastUpdateDate": "04/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHIRINIAN",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "KARO",
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "818-454-6382",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}