Healthcare Provider Details

I. General information

NPI: 1710108246
Provider Name (Legal Business Name): SCOTT BURNETT SILLIMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/20/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W CLINTON ST
GRAY GA
31032-5430
US

IV. Provider business mailing address

1051 SCULL SHOALS DR
GREENSBORO GA
30642-4919
US

V. Phone/Fax

Practice location:
  • Phone: 478-986-1830
  • Fax:
Mailing address:
  • Phone: 678-520-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN010932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: