| NPI | 1174635882 |
|---|---|
| Former Legal Business Name | GILLIAM DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANNA MARIA JOHNSON Office Manager 910-577-5077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 5688) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 6034) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |