Pawan Gautam, MDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DDS103359 Issued in CA

Practice address

210 E Flamingo Rd
Unit 217
Las Vegas, NV 89169-4793

Phone

(760) 447-2655

NPI assigned

Dec 5, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1053742742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E FLAMINGO RD",
            "address_2": "UNIT 217",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891694793",
            "telephone_number": "760-447-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E FLAMINGO RD",
            "address_2": "UNIT 217",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891694793",
            "telephone_number": "760-447-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTAM",
        "first_name": "PAWAN",
        "name_prefix": "Dr.",
        "credential": "MDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-05",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NV",
            "license": "S3-245C",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "DDS103359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brigida Gaudiel
• Kerstine Mari San Diego Gaudiel
• Shantae Gauff
• Luke Gaughan, OT
• Lauren Elizabeth Ewa Gaumond
• Brian Jay Gauthier, LCSW, LADC
• Clifford Gauthier
• Mary Ellen Gauthier, APRN-BC
• Robin Gauthier
• Zoe Helina Gauthier, D.O.

• Orthodontics and Dentofacial Orthopedics Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.