# RICHARD S GILLUM INC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639467913
- **Authorized official:** MRS. SHELLEY D GILLUM (OFFICE MANAGER)
- **Authorized official phone:** (317) 888-7576

## Contact information

- **Practice address:** 1259 N STATE ROAD 135, SUITE E, GREENWOOD, IN 46142-1033
- **Practice address phone:** (317) 888-7576
- **Practice address fax:** (317) 888-0047
- **Mailing address:** 1259 N STATE ROAD 135, SUITE E, GREENWOOD, IN 46142-1033
- **Mailing address phone:** (317) 888-7576
- **Mailing address fax:** (317) 888-0047

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12008573 | IN | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 07/20/2011
- **Last updated:** 05/17/2012