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NPI Code Detail

MEDICARE: DR. COLLEEN MARY GUILLIAT D.D.S.

MEDICARE: DR. COLLEEN MARY GUILLIAT D.D.S.
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
11223G0001XGeneral Practice Dentistry2901017701MI

General Provider Information

NPI Number : 1912067588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COLLEEN MARY GUILLIAT D.D.S.
Provider Business Mailing Address
First Line : 4018 LAPEER RD
Second Line :
City : PORT HURON
State : MI
Zip : 48060-7775
Country : US
Telephone Number : 810-987-3823
Fax Number : 810-987-0182
Provider Business Practice Location Address
First Line : 4018 LAPEER RD
Second Line :
City : PORT HURON
State : MI
Zip : 48060-7775
Country : US
Telephone Number : 810-987-3823
Fax Number : 810-987-0182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 07/08/2007

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