Provider Demographics
NPI:1629426119
Name:BILIK, DANA (RDH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:BILIK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 POPE AVE
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2332
Mailing Address - Country:US
Mailing Address - Phone:913-684-5516
Mailing Address - Fax:
Practice Address - Street 1:520 POPE AVE
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH011288124Q00000X
VA0402203270124Q00000X
PADH009142L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist