Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DT2060 | HI |
Y | 1223E0200X | Endodontist | S7-125 | NV |
NPI | 1114017274 |
---|---|
Provider Name | Dr. Paul William Guevara |
First Address | Las Vegas, NV 89134-5220 |
Second Address | Henderson, NV 89014-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 06/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54089001 | (05) | HI |