Provider Demographics
NPI:1164941266
Name:GUILLIOT, CHELSEA MAE-PRIDGEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:MAE-PRIDGEN
Last Name:GUILLIOT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5342
Mailing Address - Country:US
Mailing Address - Phone:215-589-0977
Mailing Address - Fax:
Practice Address - Street 1:600 RUE DE ONETTA
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2163
Practice Address - Country:US
Practice Address - Phone:337-376-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist