NPIMap

Individual provider Active NPI

Paul William Guevara, DMD

  • Endodontics
  • Henderson, NV
National Provider Identifier
1114017274
Registry record updated Feb 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
S7-125 Issued in NV
Practice address
4301 E Sunset Rd Ste 100
Henderson, NV 89014-2238
Phone
(702) 465-8187
Fax
(808) 425-9486
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DT2060 HI
Endodontics 1223E0200X S7-125 NV Primary

Addresses

Primary practice location

4301 E Sunset Rd Ste 100
Henderson, NV 89014-2238

Mailing address

10615 Mission Lakes Ave Ste 406
Las Vegas, NV 89134-5220
Phone (808) 780-7025

Other practice location 1

94-673 Kupuohi St Ste C104
Waipahu, HI 96797-5372
Phone (808) 677-3373

Other identifiers 1

IdentifierTypeStateIssuer
54089001MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DT2060HIMDDentist
S7-125NVMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Endodontic Associates Inc Endodontics Past Accepting new patients
Mugleston Green Valley Modern Dentistry, PC PastSince Feb 13, 2022 Accepting new patients
Endodontic Associates Inc Endodontics Past Accepting new patients

Organizations & group practices 3

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644105600000",
    "number": "1114017274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10615 MISSION LAKES AVE STE 406",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891345220",
            "telephone_number": "808-780-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 E SUNSET RD STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142238",
            "telephone_number": "702-465-8187",
            "fax_number": "808-425-9486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "94-673 Kupuohi St Ste C104",
            "address_purpose": "LOCATION",
            "city": "Waipahu",
            "state": "HI",
            "postal_code": "967975372",
            "country_code": "US",
            "telephone_number": "808-677-3373",
            "fax_number": "808-677-3323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUEVARA",
        "first_name": "PAUL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2022-02-06",
        "certification_date": "2022-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "HI",
            "license": "DT2060",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NV",
            "license": "S7-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54089001",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2022; 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.