Provider Demographics
NPI:1033244371
Name:GUILLORY, GARY PETER (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PETER
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 HEMISFAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-3343
Mailing Address - Country:US
Mailing Address - Phone:210-978-1000
Mailing Address - Fax:
Practice Address - Street 1:155 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2632
Practice Address - Country:US
Practice Address - Phone:210-884-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16271122300000X
TX107611223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health