{
"Npi": {
"NPI": "1588397897",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CANASTILLO",
"FirstName": "PRISCILLA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RIVERA",
"OtherFirstName": "PRISCILLA",
"OtherMiddleName": "MADRIL",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DMD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "231 W THOMAS RD STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85013-4406",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-468-1991",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "111 W MONROE ST STE 131",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85003-1717",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-626-7952",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/05/2022",
"LastUpdateDate": "01/09/2025",
"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": "D011457",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}