Provider Demographics
NPI:1376639526
Name:KILLORAN, GERALD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:KILLORAN
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 1:118 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2670
Mailing Address - Country:US
Mailing Address - Phone:856-478-2467
Mailing Address - Fax:856-478-2457
Practice Address - Street 1:118 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2670
Practice Address - Country:US
Practice Address - Phone:856-478-2467
Practice Address - Fax:856-478-2457
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22DI020377001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice