MEDICARE: DR. KAELON JAMAL GUILLORY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7380	LA

General Provider Information

NPI Number	:	1205541034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAELON JAMAL GUILLORY DDS

Provider Business Mailing Address
First Line	:	2428 RUE JESANN
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-6454
Country	:	US
Telephone Number	:	504-319-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	10129 CROSSING WAY STE 400
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5892
Country	:	US
Telephone Number	:	202-806-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	10/14/2025

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