Basic Information
| Provider Information | |||||||||
| NPI: | 1174824148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUIDENG | ||||||||
| FirstName: | ROMULO | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7731 VICTORY GALLUP ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891314123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024617404 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6525 N DECATUR BLVD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891312992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025771941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2010 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6063 | NV | Y | Dental Providers | Dentist | General Practice |
No ID Information.