Richard S Gillum INC PC

NPI #1639467913 in Greenwood, Indiana

Provider Information

NPI Number: 1639467913
Entity Type: Organization
Organization Name: Richard S Gillum INC PC
Primary Specialty: Dentist
Enumeration Date: Jul 20, 2011
Last Updated: May 17, 2012

Practice Location

Address: 1259 N STATE ROAD 135
Address 2: SUITE E
City: Greenwood
State: Indiana
ZIP Code: 46142-1033
Phone: (317) 888-7576

Authorized Official

Name: MRS. SHELLEY D GILLUM
Title: OFFICE MANAGER
Phone: (317) 888-7576

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Customized Equipment — Customized Equipment	332BC3200X
Dentist	122300000X	Primary

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