Active NPI
Jack Guo
- Endodontics
- O Fallon, MO
National Provider Identifier
1669110599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2024015466
- Practice address
- 113 Church St
O Fallon, MO 63366-2894 - Phone
- (636) 362-4040
- NPI assigned
- May 20, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2024015466 | MO | Primary |
Addresses
Primary practice location
113 Church St
O Fallon, MO 63366-2894
Mailing address
2220 Mid Rivers Place Dr Apt 2220
Saint Peters, MO 63304-4438
Phone (870) 404-8258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220704000141 | AR | Order and Referring Only - Dentist | 3375923634 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784160000000",
"number": "1669110599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2220 MID RIVERS PLACE DR APT 2220",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633044438",
"telephone_number": "870-404-8258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 CHURCH ST",
"city": "O FALLON",
"state": "MO",
"postal_code": "633662894",
"telephone_number": "636-362-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUO",
"first_name": "JACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-20",
"last_updated": "2026-07-16",
"certification_date": "2026-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Endodontics",
"state": "MO",
"license": "2024015466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.