Provider Demographics
NPI:1972607570
Name:GILLILAND, RICK E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:E
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:122 EAST MAIN STREET
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518
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
Practice Address - Country:US
Practice Address - Phone:910-298-5111
Practice Address - Fax:910-298-8398
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG1063849OtherDEA