Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 055792 | NY |
NPI | 1003137282 |
---|---|
Provider Name | Dr. Louis E Guillory |
First Address | Minneapolis, MN 55486-0036 |
Second Address | Firestone, CO 80504-6431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/03/2018 |