Provider Demographics
NPI:1639189962
Name:GUILLOT, WALTER L (DMD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:GUILLOT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 COURTHOUSE ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:228-896-0011
Mailing Address - Fax:228-896-0314
Practice Address - Street 1:302 COURTHOUSE RD
Practice Address - Street 2:SUITE E
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1890
Practice Address - Country:US
Practice Address - Phone:228-896-0011
Practice Address - Fax:228-896-0314
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS264391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist