Provider Demographics
NPI:1730300559
Name:GILLIAM, DOUGLAS BAILEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BAILEY
Last Name:GILLIAM
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 1:7493 N ORACLE RD
Mailing Address - Street 2:STE 127
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-797-8159
Mailing Address - Fax:520-797-4010
Practice Address - Street 1:7493 N ORACLE RD
Practice Address - Street 2:STE 127
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-797-8159
Practice Address - Fax:520-797-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice