Provider Demographics
NPI:1477679108
Name:GUILLEN, NORMAN
Entity Type:Individual
Prefix:DR
First Name:NORMAN
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 1:2340 WOODCREST PL
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1331
Mailing Address - Country:US
Mailing Address - Phone:205-870-9630
Mailing Address - Fax:205-870-4040
Practice Address - Street 1:2340 WOODCREST PL
Practice Address - Street 2:SUITE 240
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1331
Practice Address - Country:US
Practice Address - Phone:205-870-9630
Practice Address - Fax:205-870-4040
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL60312OtherBCBS PROVIDER NUMBER