Healthcare Provider Details

I. General information

NPI: 1295551521
Provider Name (Legal Business Name): GUO DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 JOHNSON DR
MISSION KS
66205-2912
US

IV. Provider business mailing address

5437 JOHNSON DR
MISSION KS
66205-2912
US

V. Phone/Fax

Practice location:
  • Phone: 347-749-5791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YIOU GUO
Title or Position: DENTIST
Credential: DDS., MS
Phone: 347-749-5791