Provider Demographics
NPI:1851376677
Name:GUY, KELLY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:GUY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 MERCY CT
Mailing Address - Street 2:140
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3158
Mailing Address - Country:US
Mailing Address - Phone:916-961-6644
Mailing Address - Fax:916-961-5943
Practice Address - Street 1:6600 MERCY CT
Practice Address - Street 2:SUITE 140
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3158
Practice Address - Country:US
Practice Address - Phone:916-961-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice