Provider Demographics
NPI:1417522855
Name:KILANDER, CONNOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:KILANDER
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 1:15711 MADISON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:317-590-7179
Mailing Address - Fax:
Practice Address - Street 1:15711 MADISON AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-228-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0264831223G0001X
OH30.026483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice