Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5569 | KS |
NPI | 1184872152 |
---|---|
Provider Name | Dr. Guillermo Guillen |
First Address | Overland Park, KS 66213-2617 |
Second Address | Overland Park, KS 66213-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 26/03/2010 |