Medrina B Gilliam, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2919 Issued in SC

Practice address

3217 Lakeshore Dr
Florence, SC 29501-8231

Phone

(803) 420-6344

Fax

(843) 673-0024

NPI assigned

Jan 24, 2006

Sex

Female

Sole proprietor

No

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mashpee Service Unit/Indian Health Service

  • Community Health Clinic/Center
  • Mashpee, MA
  • NPI 1992001457

  TX

  Medicare reassignment NPD
• Florence Smiles Youth Dentistry, LLC

  • General Practice Dentistry
  • Florence, SC
  • NPI 1235109042
  NPD (past)

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1952371783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 LAKESHORE DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295018231",
            "telephone_number": "803-420-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3217 LAKESHORE DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295018231",
            "telephone_number": "803-420-6344",
            "fax_number": "843-673-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "MEDRINA",
        "middle_name": "B",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z29194",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennedy Gibson
• Madeline Elizabeth Gibson, OTR/L
• Mary Gibson, RN
• Gifted Hands Care Clinic, LLC
• Tiffany Ann Gillard, FNP-C
• Alasha Gilliard
• Ashley Gilliard
• Albert T Gilpin, MD
• Gittens Chiropractic Clinic (Gittens Health and Wellness)
• David A Gittens, DC

• General Practice Dentistry in Florence, SC
• Providers in Florence, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.