Active NPI
Joan Rica Guidangen, DDS
- Dentist
- Fairbanks, AK
National Provider Identifier
1306369970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 101495
- Practice address
- 1717 W Cowles St
Fairbanks, AK 99701-5926 - Phone
- (907) 451-6682
- NPI assigned
- Jul 25, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 101495 | CA | Primary |
Addresses
Primary practice location
1717 W Cowles St
Fairbanks, AK 99701-5926
Mailing address
1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171006002217 | TX | Order and Referring Only - Dentist | 4789959529 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101495 | CA | MD | Dentist |
Interoperability endpoints
- joan.guidangen.1@15989.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500940800000",
"number": "1306369970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 W COWLES ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "907-451-6682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 W COWLES ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "907-451-6682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUIDANGEN",
"first_name": "JOAN",
"middle_name": "RICA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-25",
"last_updated": "2017-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "101495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.