Healthcare Provider Details

I. General information

NPI: 1396231478
Provider Name (Legal Business Name): SHINAN GUO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KLEBER KASERNE, MANNHEIMER STR. 3287 67657 KAISERSLAUTERN, GERMANY
APO AE
67657
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 496-371-9464
  • Fax:
Mailing address:
  • Phone: 496-371-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number36369
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010099
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: