Provider Demographics
NPI:1972042976
Name:NEWARK ORTHODONTIC CENTER - JIAFENG GU, DDS, MS, LLC
Entity Type:Organization
Organization Name:NEWARK ORTHODONTIC CENTER - JIAFENG GU, DDS, MS, LLC
Other - Org Name:NEWARK ORTHODONTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIAFENG
Authorized Official - Middle Name:
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-893-2266
Mailing Address - Street 1:974 N 21ST ST STE A-1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2990
Mailing Address - Country:US
Mailing Address - Phone:740-366-3309
Mailing Address - Fax:
Practice Address - Street 1:974 N 21ST ST STE A-1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2990
Practice Address - Country:US
Practice Address - Phone:740-366-3309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0240121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty