Provider Demographics
NPI:1316787021
Name:GUO, JESSICA LU (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LU
Last Name:GUO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 SWEETGUM LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3161
Mailing Address - Country:US
Mailing Address - Phone:610-704-6567
Mailing Address - Fax:
Practice Address - Street 1:393 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1520
Practice Address - Country:US
Practice Address - Phone:610-792-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty