Individual provider Active NPI

Corneliu Sima, DMD MSC DSC

  • Periodontics
  • Reno, NV
National Provider Identifier
1063809101
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
S4-124C Issued in NV
Practice address
10443 Double R Blvd
Reno, NV 89521-8905
Phone
(775) 521-5955
NPI assigned
Apr 15, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X DF11069 MA
Periodontics 1223P0300X S4-124C NV Primary

Addresses

Primary practice location

10443 Double R Blvd
Reno, NV 89521-8905

Mailing address

1851 Steamboat Pkwy Unit 12432
Reno, NV 89521-6386
Phone (857) 292-2284

Other practice location 1

7565 W Washington Ave Ste 101
Las Vegas, NV 89128-4334
Phone (702) 342-8631

Other practice location 2

4380 W Cactus Ave Ste 100
Las Vegas, NV 89141-8926
Phone (702) 570-0241

Other practice location 3

3119 N Rainbow Blvd
Las Vegas, NV 89108-4578
Phone (702) 342-1604

Other practice location 4

6485 N Decatur Blvd Ste 150
Las Vegas, NV 89131-2989
Phone (702) 846-5745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20230322003029 NV Order and Referring Only - DentistPractitioner - Dentist 3173999703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DF11069MAMDPeriodontist
S4-124CNVMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Ghazal Las Vegas Modern Smiles Dentistry, PC Past Accepting new patients
Shahrestani Shadow Mountain Smiles Dentistry, PC Past Accepting new patients
Gulati Highlands Dentistry, PC PastSince Mar 22, 2020 Accepting new patients
Ghazal Parkway Modern Dentistry, PC Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1063809101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 STEAMBOAT PKWY UNIT 12432",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895216386",
            "telephone_number": "857-292-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10443 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218905",
            "telephone_number": "775-521-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7565 W Washington Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891284334",
            "country_code": "US",
            "telephone_number": "702-342-8631",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4380 W Cactus Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891418926",
            "country_code": "US",
            "telephone_number": "702-570-0241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3119 N Rainbow Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891084578",
            "country_code": "US",
            "telephone_number": "702-342-1604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6485 N Decatur Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891312989",
            "country_code": "US",
            "telephone_number": "702-846-5745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMA",
        "first_name": "CORNELIU",
        "credential": "DMD MSC DSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MA",
            "license": "DF11069",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "S4-124C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.