Bonifacio Guillena III, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8712331-9922 Issued in UT

Practice address

1404 Sunriver Pkwy Ste 125
St George, UT 84790-4824

Phone

(435) 256-6167

NPI assigned

Nov 10, 2013

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Parkway Dental Group PLLC

  • General Practice Dentistry
  • St George, UT
  • NPI 1942618590
  NPD (past)

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

{
    "created_epoch": "1384041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384041600000",
    "number": "1225467293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 E CALGARY DR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907242",
            "telephone_number": "801-372-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 SUNRIVER PKWY STE 125",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904824",
            "telephone_number": "435-256-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLENA",
        "first_name": "BONIFACIO",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-10",
        "last_updated": "2013-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "8712331-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell Miles Gubler, D.D.S.
• Precious Gubler
• Zayden Gubler
• Trever Guffey
• Guided Wellness
• Robert Jordan Guillory, PHARMD
• Garyn K. Gulbranson, PSY.D.
• Loren Kyle Gulbranson, MD
• Jordyn Paige Guldenstern
• Rebecca W Gull, RN

• General Practice Dentistry in St George, UT
• Providers in St George, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2013; 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.