Provider Demographics
NPI:1699270199
Name:GUO, JING (BDS, MS, PHD)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 CYPRESS CREEK PKWY STE B1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4521
Mailing Address - Country:US
Mailing Address - Phone:281-580-9058
Mailing Address - Fax:
Practice Address - Street 1:5020 CYPRESS CREEK PKWY STE B1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4521
Practice Address - Country:US
Practice Address - Phone:213-509-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335191223E0200X, 1223E0200X
CA1023301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty