Aaron G Radmall, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

S4-99 Issued in NV

Practice address

366 W Lake Mead Pkwy #100
Henderson, NV 89015

Phone

(714) 368-2077

Fax

(714) 368-2092

NPI assigned

Nov 2, 2010

Last updated

Jan 4, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1043510399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 W LAKE MEAD PKWY #100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89015",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 W LAKE MEAD PKWY #100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89015",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADMALL",
        "first_name": "AARON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-02",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "S4-99",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Henderson, NV
• Providers in Henderson, NV by specialty
• Periodontics in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.