Provider Demographics
NPI:1396766127
Name:GUIDRY, PETER SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SCOTT
Last Name:GUIDRY
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 1:115 ELYSIAN FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6658
Mailing Address - Country:US
Mailing Address - Phone:985-714-0921
Mailing Address - Fax:
Practice Address - Street 1:2005 VEROT SCHOOL RD STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6397
Practice Address - Country:US
Practice Address - Phone:337-252-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31491223G0001X
LALA 31491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice