Provider Demographics
NPI:1417949603
Name:KILEY, ALLAN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JAMES
Last Name:KILEY
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 1:4440 NE CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7315
Mailing Address - Country:US
Mailing Address - Phone:503-648-3125
Mailing Address - Fax:503-640-0519
Practice Address - Street 1:4440 NE CORNELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7315
Practice Address - Country:US
Practice Address - Phone:503-648-3125
Practice Address - Fax:503-640-0519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR46381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice