Provider Demographics
NPI:1114017274
Name:GUEVARA, PAUL WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 MISSION LAKES AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-5220
Mailing Address - Country:US
Mailing Address - Phone:808-780-7025
Mailing Address - Fax:
Practice Address - Street 1:4301 E SUNSET RD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2238
Practice Address - Country:US
Practice Address - Phone:702-465-8187
Practice Address - Fax:808-425-9486
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2060122300000X
NVS7-1251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54089001Medicaid