Provider Demographics
NPI:1730109422
Name:GUIDRY, KIRBY J (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:J
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-233-4800
Mailing Address - Fax:337-237-2783
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-233-4800
Practice Address - Fax:337-237-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA18391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics