Provider Demographics
NPI:1225183296
Name:GUILLEN, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W A ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2947
Mailing Address - Country:US
Mailing Address - Phone:775-423-6547
Mailing Address - Fax:775-423-4278
Practice Address - Street 1:320 W A ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2947
Practice Address - Country:US
Practice Address - Phone:775-423-6547
Practice Address - Fax:775-423-4278
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice