MEDICARE: QASIYM GILLIAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	15394	MD

General Provider Information

NPI Number	:	1558780254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QASIYM GILLIAM DDS

Provider Business Mailing Address
First Line	:	7511 NEW HAMPSHIRE AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6969
Country	:	US
Telephone Number	:	301-431-6883
Fax Number	:	301-579-0027

Provider Business Practice Location Address
First Line	:	7511 NEW HAMPSHIRE AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6969
Country	:	US
Telephone Number	:	301-431-6883
Fax Number	:	301-579-0027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	05/22/2025

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