Provider Demographics
NPI:1639203953
Name:DR WILTON GUILLORY JR & DR DAVID CARLTON III
Entity Type:Organization
Organization Name:DR WILTON GUILLORY JR & DR DAVID CARLTON III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-445-4870
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty