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General NPI Number Information
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NPI Number | 1811102155
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Entity Type | Individual
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Provider Name | R TODD GILILLAND DMD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 2408 S LAMAR BLVD, STE 2
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-234-4822
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Fax | 662-234-9032
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Provider Business Mailing Address
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Address Line | P O BOX 1218
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City | OXFORD
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State | MS
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Zip | 38655-1218
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Country | US
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Telephone | 662-234-4822
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Fax | 662-234-9032
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | OR-365-02
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License Number State | MS
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