Provider Demographics
NPI:1386634186
Name:GUILLORY, WILTON A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILTON
Middle Name:A
Last Name:GUILLORY
Suffix:JR
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 1:2227 WORLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3631
Mailing Address - Country:US
Mailing Address - Phone:318-445-4870
Mailing Address - Fax:318-473-8289
Practice Address - Street 1:2227 WORLEY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3631
Practice Address - Country:US
Practice Address - Phone:318-445-4870
Practice Address - Fax:318-473-8289
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice