Provider Demographics
NPI:1053617639
Name:MICHELLE M GUO DDS PLLC
Entity type:Organization
Organization Name:MICHELLE M GUO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MENGTAO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-425-7888
Mailing Address - Street 1:29522 6 MILE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4558
Mailing Address - Country:US
Mailing Address - Phone:734-425-7888
Mailing Address - Fax:
Practice Address - Street 1:29522 6 MILE RD STE A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4558
Practice Address - Country:US
Practice Address - Phone:734-425-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010201281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty