Basic Information
Provider Information
NPI: 1396231478
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUO
FirstName: SHINAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9725 N THORNYDALE RD STE 173
Address2:  
City: TUCSON
State: AZ
PostalCode: 857425027
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 230 N DENTON TAP RD STE 115
Address2:  
City: COPPELL
State: TX
PostalCode: 750192135
CountryCode: US
TelephoneNumber: 9723939933
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2018
LastUpdateDate: 08/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XD010099AZN Dental ProvidersDentist 
122300000X36369TXY Dental ProvidersDentist 

No ID Information.


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