Healthcare Provider Details

I. General information

NPI: 1114017274
Provider Name (Legal Business Name): PAUL WILLIAM GUEVARA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 E SUNSET RD STE 100
HENDERSON NV
89014-2238
US

IV. Provider business mailing address

10615 MISSION LAKES AVE STE 406
LAS VEGAS NV
89134-5220
US

V. Phone/Fax

Practice location:
  • Phone: 702-465-8187
  • Fax: 808-425-9486
Mailing address:
  • Phone: 808-780-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT2060
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-125
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: