Individual
THOMAS BLAKE KILGORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
100 EAST NEWTON STREET, ROOM 407, BOSTON, MA 02118-2526
(617) 638-4650
(617) 638-4970
Mailing address
715 ALBANY ST, ROBINSON BUILDING B307, BOSTON, MA 02118-2526
(617) 638-4650
(617) 638-4970
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11211
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252921
—
MA
01
—
16311UH
HARVARD
—
01
—
X03644
BCBS
MA
Enumeration date
08/04/2006
Last updated
07/08/2007
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