Active NPI
James Donald Gilliam, D.D.S.
- General Practice Dentistry
- Noble, OK
National Provider Identifier
1104949767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4106
- Practice address
- 102 Woods Dr
Noble, OK 73068-9355 - Phone
- (405) 872-8423
- Fax
- (405) 872-1949
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4106 | OK | Primary |
Addresses
Primary practice location
102 Woods Dr
Noble, OK 73068-9355
Mailing address
102 Woods Dr
Noble, OK 73068-9355
Phone (405) 872-8423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4106 | OK | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wandro Dental of Noble | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Public Health Dentistry
- Noble, OK
- NPI 1548028954
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104949767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 WOODS DR",
"city": "NOBLE",
"state": "OK",
"postal_code": "730689355",
"telephone_number": "405-872-8423",
"fax_number": "405-872-1949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 WOODS DR",
"city": "NOBLE",
"state": "OK",
"postal_code": "730689355",
"telephone_number": "405-872-8423",
"fax_number": "405-872-1949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "JAMES",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "4106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Noble, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.