Provider Demographics
NPI:1992861926
Name:GILLAM, ROBERT TURNER III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TURNER
Last Name:GILLAM
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:508 E MAIN ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4494
Mailing Address - Country:US
Mailing Address - Phone:252-335-4545
Mailing Address - Fax:252-335-4842
Practice Address - Street 1:508 E MAIN ST
Practice Address - Street 2:SUITE 322
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4494
Practice Address - Country:US
Practice Address - Phone:252-335-4545
Practice Address - Fax:252-335-4842
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC78861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871094OtherUNITED CONCORDIA ID#
NC89902X2Medicaid
NC902X2OtherBLUE CROSS NC ID#