Individual provider Active NPI

Aida Flavia Cappiello, D.D.S.

  • General Practice Dentistry
  • Las Vegas, NV
National Provider Identifier
1639217466
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4883T Issued in NV
Practice address
169 N Nellis Blvd
Las Vegas, NV 89110-5320
Phone
(702) 384-1010
Fax
(702) 438-8424
NPI assigned
Feb 2, 2007
Last updated
Aug 31, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4883T NV Primary

Addresses

Primary practice location

169 N Nellis Blvd
Las Vegas, NV 89110-5320

Mailing address

526 S Tonopah Dr
Ste. 200
Las Vegas, NV 89106-4043
Phone (702) 291-2031

Other identifiers 2

IdentifierTypeStateIssuer
1639217466MedicaidNV
100510643DENTISTMedicaidNV

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161010001323 NV Order and Referring Only - Other (Non-Physician) 2961790886

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4883TNVMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1639217466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 S TONOPAH DR",
            "address_2": "STE. 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064043",
            "telephone_number": "702-291-2031",
            "fax_number": "702-366-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 N NELLIS BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891105320",
            "telephone_number": "702-384-1010",
            "fax_number": "702-438-8424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPPIELLO",
        "first_name": "AIDA",
        "middle_name": "FLAVIA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4883T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639217466",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100510643DENTIST",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.