Healthcare Provider Details

I. General information

NPI: 1235047374
Provider Name (Legal Business Name): SHELLY GUO DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 KELLIE DR
SMITHFIELD NC
27577-9443
US

IV. Provider business mailing address

620 PASTURE RIDGE RD
RALEIGH NC
27603-5384
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SHELLY GUO
Title or Position: PRESIDENT
Credential: DDS
Phone: 919-274-5173