Healthcare Provider Details

I. General information

NPI: 1679181390
Provider Name (Legal Business Name): MCGUIRE ORTHODONTICS AND FACIAL ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SOM CENTER RD STE B12
SOLON OH
44139-2911
US

IV. Provider business mailing address

6200 SOM CENTER RD STE B12
SOLON OH
44139-2911
US

V. Phone/Fax

Practice location:
  • Phone: 440-349-1129
  • Fax: 440-349-4924
Mailing address:
  • Phone: 440-349-1129
  • Fax: 440-349-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics 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: LUCAS MCGUIRE
Title or Position: OWNER
Credential: DMD
Phone: 440-349-1129