=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235047374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELLY GUO DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 KELLIE DR
-----------------------------------------------------
City | SMITHFIELD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27577-9443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-934-3636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 PASTURE RIDGE RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-5384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHELLY GUO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 919-274-5173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------