Provider Demographics
NPI:1104964055
Name:TONY GUILLEN, DDS, APC
Entity type:Organization
Organization Name:TONY GUILLEN, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-423-6547
Mailing Address - Street 1:320 W A ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2947
Mailing Address - Country:US
Mailing Address - Phone:775-423-6547
Mailing Address - Fax:775-423-4278
Practice Address - Street 1:320 W A ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2947
Practice Address - Country:US
Practice Address - Phone:775-423-6547
Practice Address - Fax:775-423-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10023844431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty