Provider Demographics
NPI:1407096407
Name:GUO, EDMUND (DDS)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ENDEAVOR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3164
Mailing Address - Country:US
Mailing Address - Phone:949-551-8877
Mailing Address - Fax:
Practice Address - Street 1:18 ENDEAVOR
Practice Address - Street 2:SUITE 308
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3164
Practice Address - Country:US
Practice Address - Phone:949-551-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0377341223P0221X
CA527271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry