=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083228308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUEVARRA DENTAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2020
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5571 SCOTTWOOD RD
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95969-5043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-824-5165
-----------------------------------------------------
Fax | 530-824-5684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 955 EAST AVE
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95926-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-410-4591
-----------------------------------------------------
Fax | 530-893-2841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PHILIP GUEVARRA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 530-410-4591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------