{
"Npi": {
"NPI": "1205244837",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "DONALD L IMAN DDS INC.",
"ParentOrgTIN": null,
"OrgName": "HEMET DENTAL CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "940 E MORTON PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HEMET",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92543-4529",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-652-5796",
"MailingAddressFaxNumber": "951-652-2145",
"FirstLinePracticeLocationAddress": "940 E MORTON PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HEMET",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92543",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-652-2796",
"PracticeLocationAddressFaxNumber": "951-652-2145",
"EnumerationDate": "07/28/2014",
"LastUpdateDate": "07/28/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IMAN",
"AuthorizedOfficialFirstName": "DONALD",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER/ CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "951-283-4626",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "30538",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}