Provider Demographics
NPI:1720165194
Name:ZILLMAN, JOHN JEFFERSON (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEFFERSON
Last Name:ZILLMAN
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 1:3507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5013
Mailing Address - Country:US
Mailing Address - Phone:913-682-1000
Mailing Address - Fax:913-682-6131
Practice Address - Street 1:3507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5013
Practice Address - Country:US
Practice Address - Phone:913-682-1000
Practice Address - Fax:913-682-6131
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice