Provider Demographics
NPI:1417165838
Name:KILLIAN, GREG A (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:A
Last Name:KILLIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 MIDDLETON SPRINGS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2273
Mailing Address - Country:US
Mailing Address - Phone:608-831-0467
Mailing Address - Fax:608-831-5108
Practice Address - Street 1:6213 MIDDLETON SPRINGS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2273
Practice Address - Country:US
Practice Address - Phone:608-831-0467
Practice Address - Fax:608-831-5108
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2108G-WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist