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Individual
MEDRINA B GILLIAM
Active
Individual
MEDRINA B GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2919
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z29194
—
SC
Enumeration date
01/24/2006
Last updated
03/14/2025
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