Provider Demographics
NPI:1801000609
Name:GILILLAND ORTHODONTICS
Entity Type:Organization
Organization Name:GILILLAND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILILLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-234-4822
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1218
Mailing Address - Country:US
Mailing Address - Phone:662-234-4822
Mailing Address - Fax:662-234-9032
Practice Address - Street 1:2408 S LAMAR BLVD, STE 2
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4012
Practice Address - Country:US
Practice Address - Phone:662-234-4822
Practice Address - Fax:662-234-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty