Individual
DR. CHARLES ROBERT GILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1695 WELLS RD, ORANGE PARK, FL 32073-6208
(904) 269-7004
Mailing address
600 SPARROW BRANCH CIR, JACKSONVILLE, FL 32259-5470
(904) 230-9571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16724
FL
Other
Enumeration date
02/19/2007
Last updated
07/08/2007
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