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General NPI Number Information
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NPI Number | 1972042976
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Entity Type | Organization
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Legal Business Name | NEWARK ORTHODONTIC CENTER - JIAFENG GU, DDS, MS, LLC
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 974 N 21ST ST STE A-1
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City | NEWARK
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State | OH
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Zip | 43055-2990
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Country | US
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Telephone | 740-366-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 974 N 21ST ST STE A-1
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City | NEWARK
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State | OH
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Zip | 43055-2990
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Country | US
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Telephone | 740-366-3309
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Fax |
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Authorized Official
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Title or Position | OWNER, ORTHODONTIST
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Name | DR. JIAFENG GU
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Credential | DDS
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Telephone | 626-893-2266
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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 | 30-024012
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License Number State | OH
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