MEDICARE: DR. JIAFENG GU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30024012	OH

General Provider Information

NPI Number	:	1801212303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIAFENG GU DDS

Provider Business Mailing Address
First Line	:	974 N 21ST ST # A-1
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-2990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	974 N 21ST ST # A-1
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-2990
Country	:	US
Telephone Number	:	740-366-3309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2014
Last Update Date	:	02/26/2024

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