Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS042844 | PA |
NPI | 1053878892 |
---|---|
Provider Name | Dr. Alexis Gilliam |
First Address | York, PA 17401-1115 |
Second Address | York, PA 17402-7620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 29/07/2020 |