Provider Demographics
NPI:1467659961
Name:FILLMORE, JAMIE L (DMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:FILLMORE
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 1:934 S LEMAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3207
Mailing Address - Country:US
Mailing Address - Phone:970-498-8300
Mailing Address - Fax:
Practice Address - Street 1:934 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3207
Practice Address - Country:US
Practice Address - Phone:970-498-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022539122300000X
CO9821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist