Provider Demographics
NPI:1588729818
Name:GILLIARD, WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:GILLIARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N HWY 52
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:843-761-1600
Mailing Address - Fax:843-761-3669
Practice Address - Street 1:255 N HWY 52
Practice Address - Street 2:SUITE 9
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-761-1600
Practice Address - Fax:843-761-3669
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC030502238Medicaid