Provider Demographics
NPI:1952333619
Name:THOMAS J KILGANNON III DDS PC
Entity Type:Organization
Organization Name:THOMAS J KILGANNON III DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KILGANNON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-359-7654
Mailing Address - Street 1:165 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983
Mailing Address - Country:US
Mailing Address - Phone:845-359-7654
Mailing Address - Fax:845-359-7656
Practice Address - Street 1:165 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983
Practice Address - Country:US
Practice Address - Phone:845-359-7654
Practice Address - Fax:845-359-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY377071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty