Provider Demographics
NPI:1205541034
Name:GUILLORY, KAELON JAMAL (DDS)
Entity type:Individual
Prefix:DR
First Name:KAELON
Middle Name:JAMAL
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 1:2428 RUE JESANN
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6454
Mailing Address - Country:US
Mailing Address - Phone:504-319-2777
Mailing Address - Fax:
Practice Address - Street 1:1562 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2356
Practice Address - Country:US
Practice Address - Phone:504-944-5200
Practice Address - Fax:504-944-5253
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty