Robert Turner Gillam III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7886 Issued in NC

Practice address

508 E Main St
Suite 322
Elizabeth City, NC 27909-4494

Phone

(252) 335-4545

Fax

(252) 335-4842

NPI assigned

Dec 27, 2006

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 3

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": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1992861926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 E MAIN ST",
            "address_2": "SUITE 322",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094494",
            "telephone_number": "252-335-4545",
            "fax_number": "252-335-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 E MAIN ST",
            "address_2": "SUITE 322",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094494",
            "telephone_number": "252-335-4545",
            "fax_number": "252-335-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLAM",
        "first_name": "ROBERT",
        "middle_name": "TURNER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID#",
            "identifier": "1871094",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902X2",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NC ID#",
            "identifier": "902X2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Teresa Mercer Godfrey, RN

• All providers in Elizabeth City, NC
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.