Individual
DR. MAXWELL L GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2 OFFICE PARK DR, JACKSONVILLE, NC 28546-7325
(910) 577-5077
(910) 577-1907
Mailing address
2 OFFICE PARK DR, JACKSONVILLE, NC 28546-7325
(910) 577-5077
(910) 577-1907
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5688
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014CY
BCBS
NC
01
—
063744
UNITED CONCORDIA
NC
05
—
8993182
—
NC
Enumeration date
07/20/2007
Last updated
07/20/2007
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