Provider Demographics
NPI:1649650540
Name:GILLIAM, BRICE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRICE
Middle Name:
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 1:2737 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5715
Mailing Address - Country:US
Mailing Address - Phone:615-973-0927
Mailing Address - Fax:
Practice Address - Street 1:2737 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5715
Practice Address - Country:US
Practice Address - Phone:615-973-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics