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General NPI Number Information
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NPI Number | 1164941266
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Entity Type | Individual
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Provider Name | CHELSEA MAE-PRIDGEN GUILLIOT D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 09/11/2017
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Provider Practice Location Address
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Address Line | 600 RUE DE ONETTA
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City | NEW IBERIA
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State | LA
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Zip | 70563-2163
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Country | US
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Telephone | 337-376-5614
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Fax |
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Provider Business Mailing Address
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Address Line | 603 CHANNEL DR
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City | BROUSSARD
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State | LA
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Zip | 70518-5342
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Country | US
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Telephone | 215-589-0977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6826
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License Number State | LA
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