Provider Demographics
NPI:1245431162
Name:KILIAN, JOHN HENRY (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:KILIAN
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-0700
Mailing Address - Country:US
Mailing Address - Phone:503-665-2177
Mailing Address - Fax:503-666-7130
Practice Address - Street 1:1540 SW 257TH AVE
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-7412
Practice Address - Country:US
Practice Address - Phone:503-665-2177
Practice Address - Fax:503-666-7130
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR50611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice