Charles Robert Gillam, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN16724 Issued in FL

Practice address

1695 Wells Rd
Orange Park, FL 32073-6208

Phone

(904) 269-7004

NPI assigned

Feb 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Bob Gillam Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affordable Dentures - Sarasota, P.a.

  • Dentist
  • Sarasota, FL
  • NPI 1477796670
  NPD (past)
• Comfortable Care Dental Health Professionals, PA

  dba The Dentist Place - Orange Park

  • General Practice Dentistry
  • Orange Park, FL
  • NPI 1679785315
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184768475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SPARROW BRANCH CIR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322595470",
            "telephone_number": "904-230-9571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 WELLS RD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320736208",
            "telephone_number": "904-269-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLAM",
        "first_name": "CHARLES",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOB",
            "last_name": "GILLAM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Radu Gheorghe, PA-C
• April Gibson
• Jessyca Christine Gibson, MD
• Christy Gieger, PA-C
• Amanda Leigh Gilbert, COTA/L
• Gilliam Solutions Group LLC
• Michael S. Gilligan, M.D.
• Garry Gillis, ATC
• Melissa Jean Gillmer, CCC-SLP
• Jacqueline Rodriguez Gilmore, MD

• Dentist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Dentist in Florida

• 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.

Verify at the official NPI Registry.