Healthcare Provider Details

I. General information

NPI: 1891553350
Provider Name (Legal Business Name): MEREDITH ROSE GUGGENHEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 HUDSON DR STE 300
HUDSON OH
44236-4454
US

IV. Provider business mailing address

5655 HUDSON DR STE 300
HUDSON OH
44236-4454
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-5437
  • Fax:
Mailing address:
  • Phone: 330-655-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.027496
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: