MEDICARE: THOMAS PATRICK GILFILLAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19A14850	IL

General Provider Information

NPI Number	:	1942403241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS PATRICK GILFILLAN D.D.S.

Provider Business Mailing Address
First Line	:	5901 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-4357
Country	:	US
Telephone Number	:	309-692-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 N KNOXVILLE AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-4357
Country	:	US
Telephone Number	:	309-692-7390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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Directions to “ THOMAS PATRICK GILFILLAN D.D.S.” Practice Location

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