Provider Demographics
NPI:1811102155
Name:GILILLAND, R TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:TODD
Last Name:GILILLAND
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:P O 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,
Practice Address - Street 2:STE 2
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-4822
Practice Address - Fax:662-234-9032
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR-365-021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics