Provider Demographics
NPI:1285752204
Name:GILILLAND, JUDSON D (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:D
Last Name:GILILLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MUNICIPAL DR
Mailing Address - Street 2:STE. 114
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3559
Mailing Address - Country:US
Mailing Address - Phone:972-437-6035
Mailing Address - Fax:972-437-0333
Practice Address - Street 1:375 MUNICIPAL DR
Practice Address - Street 2:STE. 114
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3559
Practice Address - Country:US
Practice Address - Phone:972-437-6035
Practice Address - Fax:972-437-0333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#157901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice