Provider Demographics
NPI:1396978805
Name:GUILLEN, JOSE O (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:O
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 GAYLEY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3417
Mailing Address - Country:US
Mailing Address - Phone:310-208-3498
Mailing Address - Fax:702-360-2846
Practice Address - Street 1:1033 GAYLEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3417
Practice Address - Country:US
Practice Address - Phone:310-208-3498
Practice Address - Fax:702-360-2846
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist