Healthcare Provider Details

I. General information

NPI: 1245431162
Provider Name (Legal Business Name): JOHN HENRY KILIAN D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SW 257TH AVE
TROUTDALE OR
97060-7412
US

IV. Provider business mailing address

PO BOX 700
TROUTDALE OR
97060-0700
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-2177
  • Fax: 503-666-7130
Mailing address:
  • Phone: 503-665-2177
  • Fax: 503-666-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5061
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: