Healthcare Provider Details

I. General information

NPI: 1881383891
Provider Name (Legal Business Name): MAGGIE N GUAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 MISSION GORGE RD
SAN DIEGO CA
92120-3401
US

IV. Provider business mailing address

6101 MISSION GORGE RD
SAN DIEGO CA
92120-3401
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-2271
  • Fax:
Mailing address:
  • Phone: 619-272-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS110127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2023023286
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2023023286
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023023286
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: