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General NPI Number Information
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NPI Number | 1952333619
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Entity Type | Organization
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Legal Business Name | THOMAS J KILGANNON III DDS PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 165 WASHINGTON STREET
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City | TAPPAN
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State | NY
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Zip | 10983
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Country | US
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Telephone | 845-359-7654
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Fax | 845-359-7656
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Provider Business Mailing Address
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Address Line | 165 WASHINGTON STREET
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City | TAPPAN
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State | NY
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Zip | 10983
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Country | US
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Telephone | 845-359-7654
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Fax | 845-359-7656
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS JOSEPH KILGANNON III
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Credential | DDS
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Telephone | 845-359-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 377071
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License Number State | NY
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