Organization
RICHARD S GILLUM INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLEY D GILLUM (OFFICE MANAGER)
(317) 888-7576
Entity
Organization
Contact information
Practice address
1259 N STATE ROAD 135, SUITE E, GREENWOOD, IN 46142-1033
(317) 888-7576
(317) 888-0047
Mailing address
1259 N STATE ROAD 135, SUITE E, GREENWOOD, IN 46142-1033
(317) 888-7576
(317) 888-0047
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008573
IN
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/20/2011
Last updated
05/17/2012
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