Gary Edward Prillaman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4247 Issued in NC

Practice address

118 Hospital St
Mocksville, NC 27028-2008

Phone

(336) 751-6289

Fax

(336) 751-3855

NPI assigned

Jan 19, 2006

Last updated

Jul 10, 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1285614917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 HOSPITAL ST",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 HOSPITAL ST",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282008",
            "telephone_number": "336-751-6289",
            "fax_number": "336-751-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRILLAMAN",
        "first_name": "GARY",
        "middle_name": "EDWARD",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8997125",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Piedmont Healthcare, PA
• Piedmont Healthcare, PA
• Pine Forrest Farm Inc (Pine Forrest Residential Care)
• Shamika Yolanda Pompey, MSW, LCSW-A
• John Naylor Price, MD
• Hannah Prillaman, LCMHCA
• Proactive MD NC, PC (Proactive MD - Brakebush Health Center - Mocksville)
• PS Senior Living of Mocksville LLC
• Demetri Psihogios, PHARMD
• Virginia Randall

• General Practice Dentistry in Mocksville, NC
• Providers in Mocksville, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.