Provider Demographics
NPI:1477694412
Name:SCHILLER, LARY JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARY
Middle Name:JAY
Last Name:SCHILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2918
Mailing Address - Country:US
Mailing Address - Phone:415-861-5545
Mailing Address - Fax:415-552-2036
Practice Address - Street 1:345 W PORTAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1429
Practice Address - Country:US
Practice Address - Phone:415-664-4532
Practice Address - Fax:415-664-5279
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics