Provider Demographics
NPI:1053878892
Name:GILLIAM, ALEXIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
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 1:241 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1115
Mailing Address - Country:US
Mailing Address - Phone:910-389-6031
Mailing Address - Fax:
Practice Address - Street 1:2820 WHITEFORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-7620
Practice Address - Country:US
Practice Address - Phone:717-885-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0428441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry