{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PAVILION SMILE DENTAL CARE",
"ParentOrgTIN": null,
"OrgName": "LUZVIMINDA V DAYRIT DDS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5680 GRATA VISTA CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91737-2350",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-756-4780",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2094 W REDLANDS BLVD STE F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REDLANDS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92373-6266",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-792-0500",
"PracticeLocationAddressFaxNumber": "909-792-0598",
"EnumerationDate": "04/20/2021",
"LastUpdateDate": "05/13/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAYRIT",
"AuthorizedOfficialFirstName": "LUZVIMINDA",
"AuthorizedOfficialMiddleName": "V",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "909-463-6646",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}