Provider Demographics
NPI:1215947122
Name:GUILLORY, MARK RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAY
Last Name:GUILLORY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BELCHER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-3654
Mailing Address - Country:US
Mailing Address - Phone:281-592-6398
Mailing Address - Fax:
Practice Address - Street 1:400 BELCHER ST STE 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-3654
Practice Address - Country:US
Practice Address - Phone:281-592-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA76471223G0001X
TX207261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice