Provider Demographics
NPI:1538220546
Name:KILFOY, AYSE (DMD)
Entity type:Individual
Prefix:DR
First Name:AYSE
Middle Name:
Last Name:KILFOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WOODLAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366
Mailing Address - Country:US
Mailing Address - Phone:636-240-9211
Mailing Address - Fax:636-978-9610
Practice Address - Street 1:608 WOODLAWN AVENUE
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366
Practice Address - Country:US
Practice Address - Phone:636-240-9211
Practice Address - Fax:636-978-9610
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0147681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice