Active NPI
Guy William Mendivil, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bakersfield, CA
National Provider Identifier
1912054271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- D29737
- Practice address
- 11901 Bolthouse Dr Ste 200
Bakersfield, CA 93311-8456 - Phone
- (661) 323-5910
- Fax
- (661) 323-5911
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | D29737 | CA | Primary |
Addresses
Primary practice location
11901 Bolthouse Dr Ste 200
Bakersfield, CA 93311-8456
Mailing address
11901 Bolthouse Dr Ste 200
Bakersfield, CA 93311-8456
Phone (661) 323-5910
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D629737 | Other | CA | DELTA DENTAL PREFIX ID |
| G93914-01 | Medicaid | CA | |
| CGP170062 | Medicaid | CA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| D29737 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guy W Mendivil DDS Professional Dental Corp | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bakersfield, CA
- NPI 1255477592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1912054271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11901 BOLTHOUSE DR STE 200",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933118456",
"telephone_number": "661-323-5910",
"fax_number": "661-323-5911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11901 BOLTHOUSE DR STE 200",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933118456",
"telephone_number": "661-323-5910",
"fax_number": "661-323-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDIVIL",
"first_name": "GUY",
"middle_name": "WILLIAM",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "D29737",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL PREFIX ID",
"identifier": "D629737",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G93914-01",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CGP170062",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.