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General NPI Number Information
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NPI Number | 1255881868
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Entity Type | Individual
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Provider Name | HUIYAN GUAN D.D.S.,M.S
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Gender | Female
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 400C SOUTHPARK BLVD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2974
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Country | US
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Telephone | 804-526-4889
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Fax |
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Provider Business Mailing Address
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Address Line | 400C SOUTHPARK BLVD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2974
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Country | US
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Telephone | 804-823-9543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019.030964
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401415389
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License Number State | VA
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