=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144197880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUILHERME GAYER MADUREIRA DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 PISGAH CHURCH RD
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27455-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-271-7900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 W 4TH ST APT 334
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-3861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 445-448-5248
-----------------------------------------------------
Fax | 445-448-5248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0302
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------