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General NPI Number Information
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NPI Number | 1205541034
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Entity Type | Individual
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Provider Name | KAELON JAMAL GUILLORY DDS
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Gender | Male
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 10129 CROSSING WAY STE 400
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-5892
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Country | US
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Telephone | 202-806-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 RUE JESANN
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City | MARRERO
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State | LA
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Zip | 70072-6454
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Country | US
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Telephone | 504-319-2777
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7380
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License Number State | LA
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