Basic Information
| Provider Information | |||||||||
| NPI: | 1932770328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUINDO | ||||||||
| FirstName: | AMADOU | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16165 CARRIAGE LAMP DR APT 614 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174025323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2888 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138754200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2021 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902016818 | MI | Y | Dental Providers | Dental Hygienist |
No ID Information.