Provider Demographics
NPI:1386253664
Name:GILLIAM, KARA DUNEGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:DUNEGAN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5707
Mailing Address - Country:US
Mailing Address - Phone:703-994-5308
Mailing Address - Fax:
Practice Address - Street 1:4909 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1649
Practice Address - Country:US
Practice Address - Phone:804-355-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014171831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXETN785OtherETN