Provider Demographics
NPI:1992147730
Name:IMPLANT & DENTAL ART, PLLC
Entity type:Organization
Organization Name:IMPLANT & DENTAL ART, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, PHD
Authorized Official - Phone:703-992-0674
Mailing Address - Street 1:8321 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3817
Mailing Address - Country:US
Mailing Address - Phone:703-992-0674
Mailing Address - Fax:
Practice Address - Street 1:8321 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3817
Practice Address - Country:US
Practice Address - Phone:703-992-0674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014126011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty