Healthcare Provider Details

I. General information

NPI: 1952333619
Provider Name (Legal Business Name): THOMAS J KILGANNON III DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WASHINGTON STREET
TAPPAN NY
10983
US

IV. Provider business mailing address

165 WASHINGTON STREET
TAPPAN NY
10983
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-7654
  • Fax: 845-359-7656
Mailing address:
  • Phone: 845-359-7654
  • Fax: 845-359-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number377071
License Number StateNY

VIII. Authorized Official

Name: THOMAS JOSEPH KILGANNON III
Title or Position: OWNER
Credential: DDS
Phone: 845-359-7654