Individual ProviderMaxwell L GilliamDentistDental ProvidersPractice Address2 Office Park Dr, Jacksonville, NC 28546-7325(910) 577-5077PECOS EnrollmentBased on the most recent information from CMS, provider Maxwell L Gilliam does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1407056153Provider TypeIndividualFull NameGilliam, Maxwell LTitleDr.CredentialD.D.S.GenderMaleSole ProprietorNoEnumeration Date7/20/2007Last Updated7/20/2007Contact InformationPractice LocationPractice Address2 Office Park Dr, Jacksonville, NC 28546-7325Phone(910) 577-5077Fax(910) 577-1907Mailing LocationMailing Address2 Office Park Dr, Jacksonville, NC 28546-7325Phone(910) 577-5077Fax(910) 577-1907Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense5688North CarolinaProvider IdentifiersIDDescriptionIssuerID063744DescriptionOtherIssuerUNITED CONCORDIANorth CarolinaID8993182DescriptionMedicaidIssuerUnlistedNorth CarolinaID014CYDescriptionOtherIssuerBCBSNorth Carolina