Active NPI
Holly Gilliland
- Dental Assistant
- Joint Base Lewis-McChord, WA
National Provider Identifier
1801580212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- D161427317
- Practice address
- 11572 17TH and C Street
Joint Base Lewis-McChord, WA 98433 - Phone
- (253) 967-4989
- Fax
- (253) 967-7216
- NPI assigned
- Jun 7, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | D161427317 | WA | Primary |
Addresses
Primary practice location
11572 17TH and C Street
Joint Base Lewis-McChord, WA 98433
Mailing address
11572 C Street
JBLM, WA 98433
Phone (253) 967-4989
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 |
|---|---|---|---|
| D161427317 | WA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686096000000",
"number": "1801580212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11572 C STREET",
"city": "JBLM",
"state": "WA",
"postal_code": "98433",
"telephone_number": "253-967-4989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11572 17TH AND C STREET",
"city": "JOINT BASE LEWIS-MCCHORD",
"state": "WA",
"postal_code": "98433",
"telephone_number": "253-967-4989",
"fax_number": "253-967-7216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLILAND",
"first_name": "HOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-07",
"last_updated": "2023-06-07",
"certification_date": "2023-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "WA",
"license": "D161427317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joint Base Lewis-McChord, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.