Provider Demographics
NPI:1891030078
Name:JERRY A KILIAN'S CANTON DENTAL ASSOCIATES PA
Entity type:Organization
Organization Name:JERRY A KILIAN'S CANTON DENTAL ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-675-3300
Mailing Address - Street 1:2700 LIGHTHOUSE PT E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4777
Mailing Address - Country:US
Mailing Address - Phone:410-675-3300
Mailing Address - Fax:410-675-3463
Practice Address - Street 1:2700 LIGHTHOUSE PT E
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4777
Practice Address - Country:US
Practice Address - Phone:410-675-3300
Practice Address - Fax:410-675-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty