Provider Demographics
NPI:1417044199
Name:RICK E. GILLILAND, D.M.D. P.A.
Entity Type:Organization
Organization Name:RICK E. GILLILAND, D.M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-298-5111
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-0749
Mailing Address - Country:US
Mailing Address - Phone:910-298-5111
Mailing Address - Fax:910-298-8398
Practice Address - Street 1:122 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-0749
Practice Address - Country:US
Practice Address - Phone:910-298-5111
Practice Address - Fax:910-298-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty