Healthcare Provider Details

I. General information

NPI: 1700798246
Provider Name (Legal Business Name): GUAN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4336 BRECKSVILLE RD STE C
RICHFIELD OH
44286-9248
US

IV. Provider business mailing address

6583 WALNUT CT
HUDSON OH
44236-5548
US

V. Phone/Fax

Practice location:
  • Phone: 330-659-9363
  • Fax:
Mailing address:
  • Phone: 734-277-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: XIAOMU GUAN
Title or Position: OWNER
Credential: DMD
Phone: 734-277-1263