Bruce Gilliam, Connie
Bruce Gilliam, Connie is an individual health care provider with primary practice located at 2 Office Park Dr , Jacksonville NC 28546-7325. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Bruce Gilliam, Connie can be contacted via phone (910) 577-5077.Contact Information
Primary practice address
2 Office Park Dr
Jacksonville NC 28546-7325
Phone: (910) 577-5077
Fax: (910) 577-1907
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 6034 | North Carolina |
Profile Details
| NPI number | 1548460298 |
|---|---|
| LBN Legal business name | Bruce Gilliam, Connie |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 20th, 2007 |
| Last updated | Oct 31st, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548460298 | NPPES |
| North Carolina | Other | 060913 | UNITED CONCORDIA |
| North Carolina | MEDICAID | 8993221 | UNITED CONCORDIA |
| North Carolina | Other | 014CY | UNITED CONCORDIA |
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