Healthcare Provider Details

I. General information

NPI: 1417044199
Provider Name (Legal Business Name): RICK E. GILLILAND, D.M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 EAST MAIN STREET
BEULAVILLE NC
28518-0749
US

IV. Provider business mailing address

PO BOX 749
BEULAVILLE NC
28518-0749
US

V. Phone/Fax

Practice location:
  • Phone: 910-298-5111
  • Fax: 910-298-8398
Mailing address:
  • Phone: 910-298-5111
  • Fax: 910-298-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICK E GILLILAND
Title or Position: OWNER
Credential: D.M.D.
Phone: 910-298-5111