Provider Demographics
NPI:1225269046
Name:GUO, MICHELLE MENGTAO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MENGTAO
Last Name:GUO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:MENGTAO
Other - Middle Name:
Other - Last Name:GUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
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:734-758-8888
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:734-758-8888
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0230901223G0001X
MI29010201281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice