=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801000609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILILLAND ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2408 S LAMAR BLVD, STE 2
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-4012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-4822
-----------------------------------------------------
Fax | 662-234-9032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1218
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-4822
-----------------------------------------------------
Fax | 662-234-9032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TODD GILILLAND
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 662-234-4822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------