Individual
GARY EDWARD PRILLAMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
118 HOSPITAL ST, MOCKSVILLE, NC 27028-2008
(336) 751-6289
(336) 751-3855
Mailing address
118 HOSPITAL ST, MOCKSVILLE, NC 27028-2008
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4247
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8997125
—
NC
Enumeration date
01/19/2006
Last updated
07/10/2007
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