Provider Demographics
NPI:1447267331
Name:GILLIAM, PAUL LAWRENCE (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LAWRENCE
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 MALLORY LN
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2931
Mailing Address - Country:US
Mailing Address - Phone:615-370-8945
Mailing Address - Fax:615-370-0765
Practice Address - Street 1:1749 MALLORY LN
Practice Address - Street 2:SUITE 245
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2931
Practice Address - Country:US
Practice Address - Phone:615-370-8945
Practice Address - Fax:615-370-0765
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS003776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist