Gilliam, Maxwell L
Gilliam, Maxwell L is an individual health care provider with primary practice located at 2 Office Park Dr , Jacksonville NC 28546-7325. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Gilliam, Maxwell L 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 / General Practice | 1223G0001X | 5688 | North Carolina |
Profile Details
| NPI number | 1407056153 |
|---|---|
| LBN Legal business name | Gilliam, Maxwell L |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 20th, 2007 |
| Last updated | Jul 20th, 2007 - about 17 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 | 1407056153 | NPPES |
| North Carolina | Other | 063744 | UNITED CONCORDIA |
| North Carolina | MEDICAID | 8993182 | UNITED CONCORDIA |
| North Carolina | Other | 014CY | UNITED CONCORDIA |
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