Provider Demographics
NPI:1154487999
Name:GUILLEN, RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 LANCASTER DR NE
Mailing Address - Street 2:#109
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305
Mailing Address - Country:US
Mailing Address - Phone:503-375-9282
Mailing Address - Fax:503-375-2257
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:#109
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305
Practice Address - Country:US
Practice Address - Phone:503-375-9282
Practice Address - Fax:503-375-2257
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist